Navigating Insurance and Pain Medicine Constraints in Pain Management

Home/Monthly Medical Minutes, News/Navigating Insurance and Pain Medicine Constraints in Pain Management

Navigating Insurance and Pain Medicine Constraints in Pain Management

woman filling out medical paperworkWith today’s many diversified insurance providers and plans, along with a growing opioid epidemic, it can be confusing – and frustrating – to patients get the services they need and deserve because of limited insurance benefits and some of the restrictive guidelines medical practices must follow surrounding treatment options.

An article in the WebMD Medical Reference library references the health plan considerations: If you bought a health plan through your state’s Marketplace, on the individual market, or have insurance through your small employer, your health plan must cover a core package of benefits under the Affordable Care Act called essential health benefits. You may still have to meet your deductible first and pay a portion of the cost, except for some preventive services. While health plans offered by large employers are not required to include these essential health benefits, almost all do. The pain management benefits include:

  • Prescription drug coverage
  • Chronic disease management
  • Emergency care
  • Hospital care
  • Mental health services

In many cases, a referral is not needed for pain management coverage, but Piedmont Interventional Pain Care can help verify insurance coverage, deductibles and out-of-pocket costs associated with treatment.

Factor in the additional delicate nature of pain management. While our practice goal is to offer interventional treatment (minimally invasive, non-surgical options), there are some patients who may require some prescription pain medicines to help alleviate their discomfort.

Pain medicines – including opioids – are often used for short and longer-term management of pain depending on the individual’s condition. It is the responsibility of our practice to assure we follow the most stringent guidelines in prescribing pain medications.

Piedmont Interventional Pain Care patients who receive certain prescriptions are monitored via drug testing provided in the practice’s in-house laboratory.  Pills must be counted and use documented. This is for the welfare of the patient as well as to prevent the unfortunate abuse of prescription drugs.

Our medical director, Dr. Robert B. Wilson, II, takes medication management an extra step and devotes additional personal time to helping set policies, establish regulations and ways to help fight the opioid epidemic in our state.

Dr. Wilson serves as a committee member of the Opioid Task Force-North Carolina Industrial Commission developing rules for opioids, related prescriptions, and pain management treatment in workers’ compensation claims. Additionally, he is a committee member of the Opioid Task Force of the North Carolina Medical Board and serves on the Health and Human Services (NC DHHS) Drug Abuse Advisory Committee.

So while the medical providers and staff of Piedmont Interventional Pain Care are always committed to providing the highest level of services and care to our patients, there are steps set by the government, insurance providers and other governing bodies designating what we must do to to continue to reach that exceptional benchmark in healthcare. The need for a referral, insurance verification and drug testing are just part of our diligence to not only assure we always maintain the highest standards in our practice, but we safeguard the health and welfare of all of our patients.




American Society of Anesthesiologists: “Pain Medicine.”

Institute of Medicine: “Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research.”

U.S. Preventive Services Task Force: “USPSTF A and B Recommendations.”

Robert Wood Johnson Foundation: “Chronic Disease Management.”

Kaiser Family Foundation: “Health Law Boosts Status Of Alternative Medicine — At Least On Paper.”

American Chiropractic Association: “A Blueprint for Relieving Pain.”

Centers for Medicare and Medicaid Services: “Acupuncture,” “Chiropractic Services.”

Community Catalyst and the Center for Health Insurance Studies, Georgetown University Health Policy Institute: “Essential Benefit Package.”

Bastyr University: “Health Care Law Creates Openings for CAM Fields.” “Closing the Coverage Gap – Medicare Prescription Drugs Are Becoming More Affordable.”

American Cancer Society: “Health Insurance and Financial Assistance for the Cancer Patient.”

© 2017 WebMD, LLC. All rights reserved.