Chronic Pain and Insurance Companies – Some Thoughts

Chronic Pain and Insurance Companies – Some Thoughts

As we have heard from more readers, an interesting theme has emerged from pain patients who are having either a difficult time finding a doctor who will treat them or are concerned about the type of treatment they are getting.

Steve Ariens, the retired pharmacist who is an articulate advocate for the pain patient, wrote in our comment section some advice for patients who have insurance but are having a hard time finding a doctor to treat them. His advice seems worth sharing for a wider audience.

“For those who have insurance and can’t find a provider to take care of your needs… you need to contact your insurance company… Most likely they have a network of physicians and pharmacies that are within their network… that have agreed to treat pts with the particular insurance. Tell the insurance company… you will probably have to talk to someone higher up than those who just answer the phone… that they need to find a provider to take care of your needs that covered under your policy…  If they blow you off… contact state insurance commissioner or if you are on Medicare/Medicaid/Medicare Advantage… and tell them that your insurance company is compromising your quality of life… by not helping you find someone to treat your medical issues and committing fraud for accepting premiums and not providing covered services.”

Steve’s web page is chock full of advice for patients. Take a look.

Another topic that has come up is the whole issue of treatment. As you know, the National Pain Report is promoting a survey by Terri Lewis, Ph.D  that is probing issues around the National Pain Strategy. The response to the survey has been robust and Dr. Lewis is just beginning to assess the results which she will share with us in the future.

She said the influence of insurance companies on pain management choices has been a frequent theme.

“While we would like to believe that the ‘working alliance’ between patients and their providers is a matter of choice,  communication, and collaboration, the treatment relationship is impaired by insurance limitations – for drugs that will be reimbursed, copay structures, step wise and fail first policies that force out medications with lesser effectiveness, and so forth.  The influence of different types of insurance such as Medicare part D, Medicaid, Workman’s compensation, private insurance, or no insurance at all imposes restrictions on prescribing, dispensing, adherence to treatment regimens, and the availability of patient financial resources to meet copays. ”

Dr. Lewis, who is the daughter and mother of chronic pain patients, thinks the health care system is not geared to appropriately treat chronic pain (and other chronic disease patients.  She talked about that in an interview with us.

“Too often, precious professional time that should be spent with patients is spent on the telephone wrangling with prior approvals or making the case for specific medications with known patient history of effectiveness. This is of particular issue when patients migrate from one health care plan to another, when they change providers, or when they move from one location to another. Payor sources lack reciprocal agreements to accept prior patient treatment protocols, a fact which is disruptive to patient care and which forces physicians to play medication roulette. Patients, their providers, and the system effectiveness suffers. An important example of this failure is the very current concern over the drug Tramadol, now associated with hypoglycemia and suicidal ideation. In our survey, patients report that many of their prescribing physicians, fearing scrutiny by DEA over prescribing practices, have supplanted long standing opioid protocols with Tramadol to no reported effect except that of  increased pain and illness, reduced quality of life. More than one respondent has expressed clearly that under these circumstances, the consideration of suicide and waiting for death to come is a viable option.”

Have you spoken with your insurance company? Has it been helpful? Share with us in the comments section below.






Authored by: Ed Coghlan

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I have had pretty good luck except when it has come to muscles relaxers. I have tried several and for various reasons I can’t take the. The doctor wrote me a new one the other day but when I went to pick it up they said the insurance won’t cover it. So pretty much this will be my 3rd night with no sleep as the spasms haven’t stopped in my back and legs in days. Very sad and wonder how they determine what they pay for and what not

Terri Lewis

Veronica your frustration is palpable. It is long past time for patients who deal with chronic pain to be afforded the opportunity to participate in telemedicine and telepharmacy practices – whether they live in urban or rural areas. One of the reasons for conducting the patient pain survey is to document these experiences as real and valid impediments to delivery of care to persons with chronic pain. There are emerging models in rural areas that have been overlooked including telemedicine, and telehealth collaboratives. These are very important and useful approaches to delivering treatment to persons with unique health care needs who live in remote hard to serve areas or what what I refer to as pain deserts. Digital apps and tools are already in the hands of professionals – the goal should be to place them into the hands of qualified patients.
We must apply pressure on the professional practice associations to addresses these problems of health care delivery – state health boards, licensing agencies, pharmacy groups, mental health service providers and so forth. We must apply constructive pressure based on evidence that serving persons with unique health care needs through qualified, knowledgable practitioners is as important to business design and development as chasing the latest in tools and equipment for testing. This is a reframing and redistribution of health care resources issue that if we don’t solve, will continue to contribute to keeping health care costs higher than they need to be for all of us. It is unacceptable to continue to ignore barriers to health care access.

Veronica Clark

As valuable as the suggestions are, or were, in the pharmacists article…..I have to say this: I live in a rural area, so the suggested doctors that were given to me were at least 90 miles away from my home, 1-way. Since driving causes, or I should say brings on, severe migraines, I can’t take up their suggestions. I’m stuck, period. My children can only do so much as far as help goes, as they work and have children of their own, and my husband works out of state for long periods at a time. I feel as though there is no help at all, anywhere. My neurologist is the only one who even attempts to help, but even she is saying I need to see another doctor, who is an almost 3 hour drive 1-way, away. I’m going next week, only because I want more answers and am hoping to find them. I don’t have much faith that I will get answers after what I’ve been put through, but I have to try…. I do want to thank the pharmacist for his suggestions, as they will help many…just not me.


Unfortunately the Pain Doctor that I see David Ryan-Marks MD and his two Nurse Practitioners seem to be the ONLY PAIN PRACTICE IN THE STATE OF CT that takes my Insurance. Unfortunately for me I was in Pain Treatment before and I am what is referred to as Opioid Tolerant but the dosage I am prescribed has not made a significant difference so I remain unable to function. I have Arthritis and my joints are so painful that most days I am unable to do even simple things without extreme pain. I find it difficult to get through a grocery store. When I tell the doctor this they say that they will not prescribe a higher dose even though they believe my pain is legitimate and not being addressed properly. It is already apparent that improperly treated pain becomes so bad it is impossible to treat. So why is it that our Healthcare system does not address pain properly. The INCREASED STRESS BOTH PHYSICAL AND PSYCHOLOGICAL IS VERY DAMAGING AND MOST PAIN PATIENTS ARE NOT FUNCTIONING WELL IF AT ALL!! THIS INCREASES BOTH THE MEDICAL COSTS AND THE INCREASED NEED FOR ASSISTANCE WITH TASKS REQUIRED TO SUSTAIN LIFE? HOW DOES THIS BENEFIT ANYONE?