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Posted by drummer ( on October 09, 1999 at 11:02:57:

In Reply to: O2 and insurance posted by Tim M on October 09, 1999 at 09:01:14:

This issue of Oxygen and Cluster Headaches and Health Insurance Companies comes up on the message board quite often. I understand the frustration. “Been there done that”. (My health insurance company is Blue Cross Blue Shield). They used to NOT pay for Oxygen for the treatment of Cluster Headache. Now they do. Why? Because I educated BC/BS. I would suggest that you do the same. Here is how. I post this EVERYTIME that this issue is brought up on the board. Guess how much I now pay for Oxygen? I now pay NOTHING. BC/BS pays 100%. Below is how I went from paying way too much for Oxygen to paying nothing at all. I wish you luck!

Most of us KNOW that oxygen is a terrific abortive treatment for cluster headaches. Most of our doctors KNOW that oxygen is a terrific treatment for cluster headaches. Here is the problem. It is very possible that Health Insurance companies don’t KNOW of oxygen being used for cluster headache treatment; they may also not KNOW about cluster headache.

It is imperative that our doctors inform the Medical Director of our Health Insurance company, with PROOF that oxygen is a proven abortive for cluster headache. Yes, when I saw my doctor he immediately wrote a prescription for oxygen. Yes, I took the prescription to my pharmacy. No, my Health Insurance company had never heard of a cluster headache, let alone oxygen as a treatment for clusters. Therefore, they would not pay for the prescription. Health Insurance companies are very good at following the rules”. RULE #1) – DO NOT PAY FOR ANYTHING THAT IS NOT PROVEN. My doctor then changed the prescription to read “migraine-variant” instead of cluster headache. The word “migraine” was KNOWN by my Health Insurance company. They reluctantly paid.

My job now was to educate my Health Insurance company’s Medical Director. It is not the job of my Health Insurance company’s Medical Director to seek out “things to pay for”. It is my job and my doctor’s job to educate my Health Insurance company. The Medical Director now has proof of Oxygen as a treatment for cluster headache. I am now a proud sufferer of cluster headaches as opposed to a frustrated “migraine-variant” sufferer. My Health Insurance company now follows RULE #2) – MUST PAY FOR EVERYTHING THAT IS PROVEN.

I asked my Neurologist to send something to the Medical Director of my Health Insurance company so that oxygen will be covered for cluster headaches. (Notice Dr. Goadsby's name on the first enclosed reference).
Here is the deal:
Letter from my Neurologist to my Health Insurance Company:
“You have requested any documentation of oxygen for treatment of cluster headaches. There are many, many articles on the use of oxygen for cluster headaches. It is now in the textbooks that are used for headache management. I’ve enclosed copies from two textbooks on the clinical management of headache disorders”.
HEADACHE IN CLINICAL PRACTICE – Stephen D. Silberstein, Richard B. Lipton and Peter J. Goadsby. ISIS Medical Media.
Oxygen inhalation, a standard abortive treatment for cluster headache, was first used by Horton. Given via a non-breathing mask at a flow rate of 7-10L/min, it is effective in approximately 70% of patients, usually within 5 minutes. In some patients oxygen may delay rather than abort the attack, and pain may return. In a placebo-controlled study, hyperbaric oxygen (2 atm) for 30 minutes aborted an acute attack of cluster within 5-13 minutes in six of seven patients, while none of the placebo group had relief. Long-term, three patients reported complete and three patients partial interruption of their cluster cycle. Other authors have reported similar benefit of hyperbaric oxygen.

HANDBOOK OF HEADACHE MANAGEMENT – A Practical Guide to Diagnosis and Treatment of Head, Neck and Facial Pain – Joel R. Saper, M.D./Stephen Silberstein, M.D./C. David Gordon, M.D./Robert L. Hamel, P.A.-C.
Oxygen (100%) inhalation should be administered via a face mask at 7 liters/min for 10-15 minutes at a time, preferably given at the onset of the attack.

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