Insurance Red Tape Keeps Patients in Pain

November 23, 2021

By Mehal J. Desai, MD, MPH

A grandmother in need of a hip replacement, an all-American high school swimmer with a bad shoulder and a 40-year-old construction worker with nerve pain in his elbow.

These patients have very different injuries, but all three could be helped by peripheral nerve stimulation. The approach uses implanted leads to deliver doses of electricity that interrupt the brain’s ability to feel pain. The odds are low, however, that all three could access the treatment.

Many of the largest health insurers won’t cover it, even though Medicare does. One major health insurance company denied 92% of all claims.

Despite the existence of FDA-approved nerve stimulation devices to relieve painful symptoms, insurers force some patients to pick from less-than-ideal options: to keep living in debilitating pain, take a less effective and potentially addictive medication, or undergo surgery.

Peripheral nerve stimulation has been around for more than 40 years, but technological advancements in the last decade have brought the approach to the forefront of pain management. It’s a fast-acting, low-risk approach for addressing chronic and acute pain. A wide range of patients may benefit from it, but many insurers are making it hard to get.

Aside from outright denying access to PNS devices, some insurers still require patients to try and fail other therapies first, including opioids. It’s maddening when you stop to think about it – insurers risking patients’ long-term health to save some money in the short term. Treatment decisions, especially ones involving potentially addictive treatments, should be made jointly by patients and their providers – not insurance companies.

I urge insurers who aren’t covering peripheral nerve stimulation devices or other non-opioid treatment options to consider the harmful effects of their policies – and to revise them for the sake of patients in pain.

Mehal J. Desai, MD, MPH, specializes in treating pain patients in the greater Washington, D.C. area. He is also a member of the Alliance for Balanced Pain Management.

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