Pain Physicians Say Insurance Coverage Often Falls Short

Pain Physicians Say Insurance Coverage Often Falls Short

One of the nation’s largest medical organizations representing pain physicians is calling for significant changes in the way insurance companies provide coverage for pain treatment.

The American Academy of Pain Medicine (AAPM) released a position paper at its annual meeting calling on insurance payers to provide adequate coverage for interdisciplinary pain care, including physical therapy, massage, yoga, acupuncture and other alternative therapies.

painmed-300x183“Patients with persistent, ongoing pain experience endemic barriers to care, many related to non-existent or insufficient insurance coverage and reimbursement for evidence and consensus based therapies. The result is a reductionist approach to pain management whereby the default treatments are prescription (often opioids) and procedural,” the AAPM statement says.

“Interdisciplinary care has a significant evidence base in the treatment of chronic nonmalignant pain, which is not reflected in insurance coverage policies,” said Lynn Webster, MD, president of AAPM, which represents over 2,500 pain physicians and healthcare providers.

“Further difficulties with current coverage include the limited time allowed to provide comprehensive services and the routine limits commercial insurance policies place on complementary and alternative therapies and comprehensive interdisciplinary care.”

Webster added that inconsistencies in the delivery of insurance benefits for pain patients often  pushes physicians into prescribing opioid painkillers or performing surgeries when alternative treatments are available that are less risky or invasive.

The AAPM paper also calls for a minimum of three months coverage for an integrative pain management program when pain has not responded to first-line therapies.

Interdisciplinary care is marked by specialists working collaboratively to treat all aspects of a patient’s pain, including the underlying pathology, as well as the patient’s behavioral and psychosocial needs. The treatment team may vary but may include the patient, the patient’s family, physicians, nurses, psychologists, physical and occupational therapists, and others.

The AAPM paper cites evidence for interdisciplinary care as showing long-term treatment gains of up to 13 years and clear cost benefit.

Pain affects more people than heart disease, cancer and diabetes combined, and more than 100 million Americans suffer from chronic pain, according to the Institute of Medicine’s 2011 report: Relieving Pain in America, A Blueprint for Transforming Prevention, Care, Education and Research. The IOM report highlighted the burden pain imposes in disability, in use of medical services, and in destruction of quality of life and productivity.

“The IOM called for giving pain relief, research, awareness, and education the status of a national priority,” Dr. Webster said. “We are asking for changes in standards for health coverage to reflect that status.”

Authored by: Pat Anson, Editor

There are 4 comments for this article
  1. BL at 9:00 pm

    In Louisiana, Medicaid will not pay for any form of Pain Management of chronic severe pain.

  2. Dennis Kinch at 4:13 pm

    Bravo for AAPM, again standing on the correct side of the issues, the patient’s side. We patients have known for many years that insurance coverage is not only lacking, but dare I say it, criminal! All the while they make huge profits, buy more real estate and stocks, with OUR money, so they can refuse us treatment when we need it most. When one day we have socialized medicine the medical system can rightly blame the insurance industry.

  3. dave at 3:57 pm

    It should be up to people in pain what treatments are available through inusrance and not insurers, government or pain specialists at the AAPM. Frankly, the AAPM, along with insurers has a reductionistic approach to pain care which is referred to as ” the rack” in philosophical circles. It is hard for pain specialists to justify their approach as being more than an occupational strategy and all too limited to serve the needs of people in pain. Pain professionals, government and insurers isolate themselves from counterpoint and frankly shut out the views of people in pain.
    We need to democratize pain care and make special interest groups, government, and insurers more accountable to the needs of people in pain and not vice versa.