Episode 241 | How The Health Insurance Industry Perpetuates The Chronic Pain Crisis With Dr. Michael Schatman

In this episode, we are discussing the impact of the health insurance industry on the effective treatment of chronic pain. This is a topic I have been wanting to create some content around for some time. When I look back at the evolution of the show, the episodes typically fall into two buckets. I'm either talking about effective treatments, trying to build, spread awareness around conservative effective treatments for chronic pain or I'm talking about the latest, or some new research that I feel is innovative. In those two buckets, I'm also always looking for where are the problems and the barriers for us as professionals and for people living with pain to access effective pain care. When I look at the problems, there's one big problem that is like a big flashing red light, the elephant in the room. That's the health insurance industry. I asked myself, "How has this changed throughout my career?" As a physical therapist, I started practicing or treating patients in 1997. In 1997, I can't think of too many barriers for me treating a patient. When do I say that I'm talking about how much it costs a patient to access conservative pain care and then is that treatment covered? Those are the two big issues, "How much does it cost? Is it covered?" I can tell you back in 1997, I don't remember any patient having a deductible. If there was a copay or something moderate, it's maybe $5 or $10. I'm not saying as citizens, professionals and people living with pain that we shouldn't be fiscally concerned about the delivery of healthcare because that's important, especially in the United States of America. However, I can tell you in 2021, the average American contributes to their health insurance. Meaning there's typically an employee portion each month as an employee that contributes to your monthly premium. There's also an annual deductible and then there are copays on top of all of that. As people in the United States of America, this may be the most important for those of us who live in the United States but I know this impacts all of us around the world, we are paying a lot of money into our health insurance. We have to ask the question, "What are we getting back? What is the benefit that we are receiving?" The average deductible in New York City, the place where I live, is somewhere between $5,000 and $10,000 for a family plan. I have seen family plan deductibles upwards of $20,000. It's clear that premiums have increased. The second thing for us to consider is copays. When I first started in 1997, copays were maybe $5 or $10. It's not uncommon now. I have seen copays that equal the cost of the PT visits. Copays that run anywhere between $40, $50, $60 and $70 upwards to $100 to receive physical therapy care. We are paying more. However, at the same time, I have also seen visits decrease. In the United States of America, this varies depending on the diagnosis and where people live, the average length of stay for a PT session is about twelve visits. Consider you have to treat someone who has fibromyalgia and you only have two visits per week for six weeks for a total of twelve visits before the insurance company terminates care. Effectively, what large insurance companies have done is have contracted or hired third-party medical management companies, which come in. It's what they call they manage health insurance claims, which I would like to call what it is the aggressively deny claims for conservative care. This includes things like physical therapy, occupational therapy, speech, mental health services, as well as addiction treatment. Not only do they manage that care but oftentimes, insurance companies will not approve a patient seeing multiple providers. For example, insurance companies often regulate if a patient is seeing both a physical therapist and chiropractor or a PT and OT. Any combination of those, they don't like when patients are using their insurance to the fullest extent. Let's carry that over into what is identified as the gold standard for the treatment of chronic pain, which is multidisciplinary or interdisciplinary care. That's when the patient can access multiple providers. In the United States of America, we have one interdisciplinary chronic pain clinic for every million people that focus on chronic pain management. Why do we have that? Insurance companies have identified this as expensive care. It's too expensive to pay multiple providers, at the same time, they have severely cut back on those programs probably since the early '80s somewhere. That's when that trend started. That has come back somewhat but we haven't seen a revitalization of interdisciplinary chronic pain treatment programs in the United States of America specifically because insurance companies won't pay for the care. Lastly, I don't want to just focus on private health insurance companies in the United States. We have things like Medicare and Medicaid, which are government-sponsored plans. Those two have been cut every year it seems. Some emails go out by organizations, such as the American Physical Therapy Association. It's called Stop The Cut. That's where the Medicare fee schedule is reduced. Each year or every couple of years, the national government tries to reduce payments to outpatient physical therapy services. When payments are reduced, it often has an impact on the number of visits that we can see patients for and the quality of care that we can provide in an outpatient setting. The question is, "How does the health insurance industry perpetuate the chronic pain crisis?" Joining me is Dr. Michael Schatman. He is a clinical psychologist who spent many years working in multidisciplinary chronic pain management. He is on the teaching faculty of the Department of Public Health and Community Medicine at the Tufts University School of Medicine in Massachusetts and serves as Director of Research and Network Development for Boston PainCare. He has authored more than 100 journal articles and book chapters on chronic pain management and lectures regularly at the international level. He is also the Editor-in-Chief of the Journal of Pain Research. In this episode, we are going to talk about the health insurance industry and how it impacts the treatment of chronic pain. This is an important episode. Make sure you share this with your friends, families and colleagues all over social media so we can raise awareness on this topic. Let's begin and meet Dr. Michael Schatman.   Love the show? Subscribe, rate, review, and share! 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