How Health Insurers Hurt People in Pain, Part II: Financial Gain Over Patient Wellbeing
How Health Insurers Hurt People in Pain
Part II: Financial Gain Over Patient Wellbeing
As covered in How Health Insurers Hurt People in Pain Part I, the differences of which pain treatments are, and are not, covered in any given insurance plan vary. This is one of numerous barriers to accessing pain treatment. But the number one impediment to effective chronic pain management is financial motives of insurance providers.
Both public and private insurers nearly always prioritize short-term cost reductions over long-term care and treatment. For instance, if a treatment is demonstrated as effective but is costly, insurance companies frequently use the categorization of the treatment as “experimental” as a payment denial tactic (Blum et al. 2018). Delaying and blocking pain treatments has serious long-term impacts. One study found that the probability of acute pain becoming a chronic disability increases with every two-week treatment delay (Schatman 2011).
Insurance companies also deny treatments or make them exceedingly difficult to obtain in order to deliberately force recipients who rely heavily on medical care to seek insurance elsewhere, or go without (Schatman 2011). Additional tactics insurance companies use to increase their profit margins are:
Denying treatment reimbursements to medical practitioners
Requiring lengthy authorizations and appeals processes
Authorizing substandard treatments or too few visits
Requiring independent medical examinations
“Carving out” or not covering comprehensive treatment
Contracting physicians to write and publish articles invalidating certain conditions, such as fibromyalgia, is another tactic of insurance companies to block covering treatments.
Just as the allegiance of private insurance is to its stakeholders, Medicare and Medicaid will often use the obligation to taxpayers and reducing state or federal spending as a rationale for denials in the name of cost saving (Blum et al. 2018). However, these decisions often result in even greater long-term expenditures and worse patient outcomes.
In a study of states whose Medicaid programs required pre-authorization for pregabalin in people with diabetic peripheral neuropathy and post herpetic neuralgia, the result was higher costs for long-term pain treatment (Schatman 2011). Higher numbers of other medications, such as opioids, were also found. Rather than putting money toward research to better understand pain and advance effective treatment, opioids have historically been pushed as a low-cost “solution” to pain (Blum et al. 2018).
In contrast, a study on pediatric pain treatment found that initial comprehensive treatment could significantly reduce health care costs, which amounted to over $27,000 in annual savings per family (Martin and Zeltzer 2018). It is estimated that 73% of pediatric chronic pain patients have pain in adulthood. Early intervention could significantly reduce both cost and severity of long-term pain.
Yet even with compelling evidence favoring comprehensive pain treatment, insurance providers are more concerned with the immediate bottom line. The result is grave outcomes for pain patients and society as a whole. But it wasn’t always this way. Read How Health Insurers Hurt People in Pain Part III: The For-Profit Insurance Takeover for a brief history.
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Sources
Blum, K, W Jacobs, E J Modestino, N DiNubile, D Baron, T McLaughlin, D Siwicki, et al. “Insurance Companies Fighting the Peer Review Empire without Any Validity: the Case for Addiction and Pain Modalities in the Face of an American Drug Epidemic.” SEJ surgery and pain. U.S. National Library of Medicine, October 4, 2018. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5998670/.
Martin, Sarah R., and Lonnie K. Zeltzer. “Prioritizing Pediatric Chronic Pain and Comprehensive Pain Treatment in the Context of the Opioid Epidemic.” Pain Management 8, no. 2 (2018): 67–70. https://doi.org/10.2217/pmt-2017-0072.
Schatman, Michael E. “The Role of the Health Insurance Industry in Perpetuating Suboptimal Pain Management.” Pain Medicine 12, no. 3 (2011): 415–26. https://doi.org/10.1111/j.1526-4637.2011.01061.x.
