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September 2nd, 2014

Advice for pain patients facing insurance challenges

People living with chronic pain face many challenges, and one of the most daunting can be finding ways to pay for treatment.   

Reimbursement policies can stand in the way of the integrated approach that is often the most successful in managing chronic pain. Vital aspects of a pain patient’s care – including specialty care services, rehabilitative services, patient education and the time needed for health care professionals to plan and coordinate care – may not be covered.

That’s one of the conclusions of the Institute of Medicine’s (IOM) report on chronic pain, “Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research.” The report states that insurance is a significant barrier to adequate care for several reasons, including the reality that a third of all Americans are uninsured or underinsured, and reimbursement policies of insurance companies “obstruct patient-centered care.” The report recommends insurance companies begin revising their reimbursement policies to “foster coordinated and evidence-based pain care.”

While the health care community overall is making progress in how it deals with chronic pain, patients still often encounter challenges when it comes to getting critical aspects of their care covered by insurance. And even when insurers do cover different types of treatments, patients may find the company unwilling or unable to help coordinate their care.

That was the experience of Joe Pierle, CEO of Missouri Primary Care Associates, a nonprofit organization committed to helping improve patient access to quality, affordable health care. Pierle lived with chronic pain for five years, and while his insurance company paid for medications, procedures and doctor’s visits, when he asked his insurer to assign a care manager to help coordinate all aspects of his treatment, the company declined.

“My pain affected everything in my life,” Pierle says. “I had a good income and good insurance, and I went to eight different doctors over 18 months. It wasn’t until I took control of my own life and care coordination that I started to feel better.”

The problem, says Michael Felix, a community health development strategist, organizer and facilitator, is that most insurance companies do not view chronic pain the same way they do other chronic diseases. Felix is also a member of the Pain Action Alliance to Implement a National Strategy (PAINS), an organization that focuses on fostering the industry changes recommended in the IOM’s report.

“We need to convince payers that chronic pain is just as costly as other chronic conditions like diabetes and asthma,” Pierle says.

Indeed, the IOM report estimates that pain costs Americans upwards of $ 635 billion every year in treatment and lost productivity.

While change in the industry has already begun, it’s vital that patients self-manage their care, Felix says. “Patients need to be committed to exercising, caring for their mental well-being, their nutrition and their sleep habits. They need to work with their health care providers to spell out what they should be doing beyond medication to manage their pain.”

By self-managing their treatment plan, patients may find their insurers provide support for making many of the lifestyle changes that contribute to successful pain management. For example, Pierle and Felix say patients should determine if their insurers help with discounts for memberships at fitness clubs, or offer educational programs for blood pressure control, smoking cessation and nutritional counseling.

“It’s all about self-management,” Felix says. “Patients need to be proactive in finding out if there are places within their community where they can access these services. Successful pain management begins with the patient and their health care provider.”

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