If you’re reading this, it’s likely you’re suffering from trigeminal neuralgia (TGN). You have probably also decided to seek treatment and get your life back from this debilitating condition. A common concern for many people when considering trigeminal neuralgia treatment options is whether or not their insurance plan will cover treatments recommended by their medical care providers. While each insurance company operates differently, many follow a common thread of thought on what should and should not be covered when patients are seeking long-term solutions to their trigeminal neuralgia symptoms.
What Is Trigeminal Neuralgia?
A chronic pain condition, trigeminal neuralgia stems from the fifth cranial nerve, also known as the trigeminal nerve. This nerve transmits sensations from various parts of your face to your brain for processing. This nerve can become irritated, sending false signals to your face and causing extreme pain, burning or pulsing, among other symptoms.
Your Treatment Options
There are four main trigeminal neuralgia treatment options: medical management, microvascular decompression surgery (MVD), Gamma Knife Radiosurgery (GKRS) and pain stimulators. Your doctor will determine which treatments will be appropriate for your case based on test results and other factors surrounding your general health.
Medical Management
Medical management is usually the first option explored by doctors for the treatment of trigeminal neuralgia. There are two medications that are considered the gold standard for treating TGN: Tegretol (carbamazepine) and Trileptal (oxcarbazepine). These are primarily used as anticonvulsants, but they have proven to be more effective in treating trigeminal neuralgia than other drugs like narcotics.
Microvascular Decompression
Microvascular decompression is the first surgery considered if medical management of TGN isn’t an option. MVD is a minimally invasive surgery that helps preserve full nerve function while eliminating symptoms.
This surgery involves removing a small piece of bone at the base of the skull. This allows the surgeon to access the trigeminal nerve and the offending blood vessel. Using tiny instruments including a microscope, the neurosurgeon carefully lifts the blood vessel away from the nerve, placing a miniature Teflon sponge between the two as a cushion. The beauty of microvascular decompression surgery is that results are almost always immediate.
Gamma Knife Radiosurgery
The next line of defense against TGN symptoms is Gamma Knife Radiosurgery. This innovative technique uses around 200 tiny beams of radiation that can be precisely targeted on a particular spot. When those beams converge, they deliver a therapeutic dose of radiation that affects only the tissue they’ve been focused on. This treatment is especially useful in cases where there is a lesion or small tumor present on or near the trigeminal nerve, or if the myelin has been damaged.
Pain Stimulator Placement
If for some reason MVD surgery or GKRS are not options, you may want to explore pain stimulator placement with your doctor. This procedure uses tiny electrodes placed under the skin and threaded to the trigeminal nerve. Tiny electrical waves are used to intercept the nerve impulses that are causing the pain and discomfort.
Which Treatments Are Covered by Insurance?
In general, all of these options are internationally recognized as viable trigeminal neuralgia treatments. This doesn’t always mean that your insurance will foot the bill for all or even any of them. Because each plan is different, it’s vital that you do some research to make sure you will be covered for whichever means of treatment you choose.
Utilizing Your Resources
You may not be aware that many practices have a benefits specialist that can help you navigate your way through the insurance maze. They can help you determine whether your neurosurgeon will be in-network or out-of-network, how much of your chosen treatment would be covered by your current insurance plan, what it may take to receive a pre-authorization, what your out-of-pocket expenses will be and other vital information.
If you prefer to do the legwork on your own, you can start with your insurance company – either online or with a rep. Be prepared to provide your surgeon’s name and tax ID number, the insurance codes associated with your desired procedure and the diagnosis code referring to your trigeminal neuralgia, along with any other related diagnostic codes.
What You Can Do If You’re Not Approved
If for some reason you are not approved for the specific procedure you’re interested in, you have two options – you can appeal the decision and provide supporting paperwork, diagnostic information, doctor’s recommendations, etc., to try and have the decision overturned. Your other option is to seek a different route of treatment. Sometimes insurance companies will push medical management, as it is the lowest-cost option in many instances. This is where documentation of medical management failure from your physician would be helpful.
Should you decide you don’t wish to fight a denial of coverage or are denied again, all is not lost. Some insurance companies may not be willing to cover MVD, but will cover Gamma Knife Radiosurgery or pain stimulators. If this is the case, make sure to have a candid discussion with your doctor to determine if these either of these would be viable trigeminal neuralgia treatment options for you.
Ultimately, the most important thing is that you are able to achieve relief from your TGN pain and discomfort. Your doctor should be willing to work closely with you to ensure that you don’t incur any more out-of-pocket expenses than you absolutely have to.
