Denial of hospitalization by insurers for inpatient treatment of medication rebound headaches.
Inpatient treatment with intravenous dihydroergotamine has been remarkably successful in managing chronic daily headaches due to excessive use of analgesics or ergotamine tartrate. Recently we have been denied authorization in appropriate patients for this procedure by third party payers on the grounds that it was "not medically necessary," "based on anecdotal information," or is "an outpatient procedure." Three cases are described in which the insurer's decision was either contested as an issue of substandard care, or the patient elected to pay for the procedure. The outcome in two cases was dramatically favorable, at least from the patient's and the physician's point of view. The third case is currently being appealed. Time and energy spent on combating the position of the third party payer on issues of standards of specialist care should be unnecessary. Publication of standards of care by specialists, and a requirement that these care standards must be provided by third party payers are needed in order that quality medical care can continue in this society.
Klapper
J A
JA
Colorado Neurology and Headache Center, Denver 80218.
D000700:Analgesics; D004878:Ergotamine; D005260:Female; D006261:Headache / Q000209:etiology / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D007297:Inpatients; D007342:Insurance Benefits; D008875:Middle Aged; D019966:Substance-Related Disorders / Q000150:complications
D000700:Analgesics; D004878:Ergotamine