Op-Ed: Arbitrary Insurance Decisions Harm Patients

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While the COVID-19 pandemic has shined a bright light on the skills and courage of healthcare providers, it also has exposed situations that can negatively impact their ability to fully and safely do their work. And when the productivity and effectiveness of healthcare providers are hindered, the biggest losers are always patients.

Over the last 90 days, we’ve seen how shortages of personal protective equipment has put both providers and patients at risk. We’ve seen how outdated scope-of-practice laws that require one qualified provider to be supervised by another provider of equal capabilities can prevent hospitals from using their workforce to full advantage.

And while it remains to be seen whether insurance companies will start making unqualified and inconsistent pandemic-related decisions about who can be reimbursed for which services, it would seem to be only a matter of time before this age-old problem rears its ugly head.

As a Certified Registered Nurse Anesthetist (CRNA) who treats chronic pain patients in rural North Carolina, I’ve learned the hard way about the often-perplexing decisions health insurers make. So have many of my patients. For example, John (not his real name) is a senior who lives with terrible back pain:

“Last year my insurance company suddenly decided not to cover the pain injections from my CRNA, even though the injections worked and had been covered for years. So my primary care doctor sent me to a physician pain specialist who had treated me unsuccessfully in the past, but he wouldn’t take me back.”

There are millions of Americans like “John” who suffer from severe, debilitating joint pain. Imagine suddenly not being able to get relief from a specialist you trusted because your insurance company decided to stop paying that specialist, even though the specialist’s education, training, certification, and licensure qualified him/her to provide the service and be paid for it.

“Eventually I was referred to a large facility much further away,” John recalled. “Three long trips. Three injections. No relief.”

For pain patients, staying close to home is essential. So imagine climbing into a car to travel a couple of hours to get injected, only for the injection to not work.

What then?

The COVID-19 pandemic may have distracted us from the opioid crisis, but it’s still very much out there. When insurers force patients to find less desirable ways to deal with chronic pain, the result is an increase in opioid-addicted pain patients.

“I hoped the injections would work where I was sent,” John said. “But when they didn’t help, I increased my medications to combat the pain. I had no life.”

For the sake of patients like John, some providers wind up doing the cases any way, eating the cost while fighting with insurers over reimbursement. But should providers who are qualified to perform a valuable service simply accept not being reimbursed just because the insurance company doesn’t feel like it? Clearly this is not a viable long-term solution for providers, patients, or our healthcare system.

What can be done to correct this so North Carolinians can safely, conveniently, and cost-effectively get the chronic pain care they need? It’s really pretty simple: CRNAs in North Carolina are already fully authorized to perform interventional pain management. Therefore, lawmakers need to eliminate the arbitrary decision-making ability of insurance companies that indiscriminately puts CRNA pain practices in jeopardy and pain patients in misery.

The alternative is ongoing, unsupported coverage denials that force patients to travel for treatment, forego treatment and live with pain, or find relief through increased opioid usage.

If you were a pain patient living in North Carolina, which would you prefer?

Michael Brown is a Certified Registered Nurse Anesthetist (CRNA) and a local pain management specialist. He lives in Fayetteville.

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