Health plan now requires chiropractic or other conservative care before allowing back surgery for chronic back pain; Are insurance companies finally learning?

Health plan now requires chiropractic or other conservative care before allowing back surgery for chronic back pain; Are insurance companies finally learning?

Years ago, people would select back surgery out of fear because their doctors recommended the option after medication and rest (two things that rarely help back problems on their own) failed to relieve the problem. The result was unnecessary surgeries that were costly and rarely fixed the problem. Rehabilitation of the back and the gait process that causes the back and sciatica issues takes time, patience and trust. Years of data now suggest that before anyone has surgery, they should minimally see a chiropractor, physical therapist or both. Many chiropractors have moved to active rehabilitation which improves the outcomes, while performing myofascial release and other methods. This has further improved outcomes with patients, especially those with disc problems. Methods such as flexion distraction are very effective as well as affordable.

From my own experience with a disc problem, I can tell you these methods work, and I avoided having surgery and was given a clean bill of health by a local neurosurgeon. It took months of flexion distraction, muscle work, acupuncture, and exercises until I was back to normal.

Now, a health plan in Pittsburgh affiliated with a major hospital is requiring conservative care referrals before surgery. This forces doctors in the system to inter refer more. Since people who are frightened by pain they do not understand and are sleep deprived by it often do not think clearly about their options, or are given all the effective options, this plan is a no brainer.

University of Pittsburgh Medical Center Health Plan mandates conservative care before considering surgery for chronic LBP cases.

Peter W. Crownfield, Executive Editor

The University of Pittsburgh Medical Center (UPMC) Health Plan, a health maintenance organization affiliated with the university’s School of Medicine, has adopted landmark guidelines for the management of chronic low back pain. As of Jan. 1, 2012, candidates for spine surgery must receive “prior authorization to determine medical necessity,” which includes verification that the patient has “tried and failed a 3-month course of conservative management that included physical therapy, chiropractic therapy, and medication.” Surgery candidates also must be graduates of the plan’s LBP health coaching program. The program features a Web-based decision-making tool designed to help plan members “understand the pros and cons of surgery and high-tech radiology.” It is the first reported implementation of such a policy by a health care plan.

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