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How to Get Your Insurer to Cover Non-Drug Treatment for Back Pain

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If you have chronic back pain, the best treatment that medical science has to offer may have nothing to do with drugs (including dangerous opioid pain relievers), and yet your insurance company might be willing to pay only for drugs! That twisted situation is a result of insurance companies not having caught up with the latest evidence that nondrug back-pain treatments can work.

Example: In a recent JAMA Network Open study of health insurance plans, only 11% covered acupuncture and 20% covered psychological counseling. Even physical therapy, covered by all, was inconsistently covered—some plans allowed only two visits.

Don’t accept this situation! If your doctor recommends trying an evidence-based nondrug treatment for back pain such as physical therapy, chiropractic, acupuncture, therapeutic massage and/or psychological counseling to relieve stress, it’s a positive sign about the doctor. Major medical organizations including the American College of Physicians now advise that these nondrug approaches should be the first thing you try. To get nondrug back-pain treatment covered…

Ask your doctor to avoid using the word “alternative” or “complementary” in any communication with insurers or in your medical chart. These are outmoded ways to describe proven approaches and may dissuade insurers. Instead, your provider can use a term such as ­“evidence-based nonpharmacologic therapy.”

If your claim is denied, ask your health-care provider to help you appeal. Your physician, physician’s assistant or nurse practitioner should send a letter to your carrier outlining the evidence for the opioid-­sparing treatment. It’s extremely helpful if she/he cites specific supporting research.

If your health insurance appeals fail, use your HSA or FSA if you have these accounts. The tax-free dollars in a health savings account (HSA) or flexible spending account (FSA) can be used for most nonmedication therapies. To decrease the odds that your use of the account will be challenged, ask your practitioner to write a prescription or note calling for the therapy and submit a copy of it when applying for reimbursement from the account.

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Source: Heather Tick, MD, who holds the Gunn-Loke Endowed Professorship of Integrative Pain Medicine at University of Washington, Seattle. She is author of Holistic Pain Relief: Dr. Tick’s Breakthrough Strategies to Manage and Eliminate Pain. HeatherTickMD.com Date: February 15, 2019 Publication: Bottom Line Personal
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