Insurance Carrier Reduce Coverage On Alternatives To Prescription Opioids
Before the opioid prescription boom in the mid-1990’s, doctors were oft accused of undertreating pain. Now, however, we have a nation full of people addicted to prescription opioids, such as oxycodone and hydrocodone.
Given the extremely addictive nature of prescription opioids, one would think that finding alternative techniques to manage pain would be of high priority for anyone involved in the medical profession.
And while an awareness of this problem is spreading, insurance companies, however, aren’t taking notice.
In increasing numbers, many insurance companies are cutting or ending reimbursements for alternative pain treatment, such as physical therapy, nerve blocks, and steroid and joint injections. Pain doctors have been advocating for these interventional therapies in lieu of painkillers for some time.
This trend with insurance companies are forcing patients and and physicians into difficult situations. Patients can pay for pricey alternative treatments themselves, go on prescription opioids that have many side effects – including addition. Or otherwise simply live with the pain.
The reason for non-coverage? For one, some procedures, despite a generous amount of evidence for effectiveness, are considered experimental – thus making them ineligible for insurance reimbursement.
Example: Radio-Frequency Ablation
One such procedure is known as radio-frequency ablation. If you haven’t heard of it, that’s probably normal.
However, its been around since 1931, and utilizes electric current to mitigate pain signals from the very nerve causing the patient pain.
Pain doctors say that this treatment has been disappearing from insurance plans. The treatment has been studied extensively, and used to be covered much more often.
And yet, insurance companies are now stating that the procedure is investigational, rather than effectual.
For example, in 2016, a United Healthcare policy referred to studies which support the use of radio frequency ablation in most cases “limited, uncontrolled, and insufficient to support conclusions regarding efficacy or duration of effect.”
But there have been at least five randomized trials for the use of radio-frequency ablation on lower back pain. This is the most common problem seen by pain physicians. Three of the five studies garnered positive results, and another was ambiguous. Furthermore, an expert review at Medscape deemed the procedure “,…the most precise method currently available” for pain physicians to help patients control their symptoms on a long-term basis.
United, Anthemand, Aetna, and various Medicare payers consider radio-frequency ablation for the sacroillac joint (lower back) experimental. And yet, there are at least nine studies involved the procedure, each of which revealed that that technique often results significantly reduced pain.
The issue has been covered by various media over the past few years. For example, a number of pain specialists in a 2014 issue of Pain Physician complained about insurance comapnies cutting many interventional pain treatments.
In the article, there was discussion over a number of reimbursement cuts in Medicare and Medicaid for epidural injections.
Later, another group published an update, stating that pain physicians are having difficulty maintaining their practices due in part to this issue.
To combat the problem, some pain specialists have started offering treatment at lower cash prices for patients whose insurance doesn’t cover alternative pain relief techniques.
The Other Side
But unfortunately, they may not be looking at the bigger picture – harm reduction. When patients get addicted to opioids, the cost of their treatment can go up significantly if they need to begin visiting an addiction specialist or enter a rehab facility.
There’s management of side effects as well – such as severe constipation.
Most insurance companies do offer an appeals process, but that can involve extensive paperwork and a time-consuming process. Thus, only worth it if the patient wins – which apparently, is not often.
One of the problems with pain is that it is subjective and can’t be measured. Moreover, it is sometimes hard to interpret evidence of efficacy for pain reduction. Indeed, a patient’s personal gauge of their own pain can vary widely.
And finally, the industry of pain medicine is relatively new. Studies are hard to recruit for, tend to be expensive and require large sample sizes. And for those with intense pain, few want to experiment with a possible placebo and wait for weeks or months for actual pain relief.
It’s understandable that insurance companies require certain qualifications for research, and are interested in the most cost-effective treatments. And, as noted above, pain is very subjective and hard to qualify. Still, opioids are found to be ineffective for long-term treatment of pain, and due to their highly addictive nature, it’s important for insurance companies to offer alternatives for pain relief.