I read an interesting article last week in a work comp blog where the author asks the question: What’s Next for Pain — Pharma? The author then discusses available medications he believes could serve as alternatives to prescription opioids. Opioid abuse is a major issue nationwide.
The article’s author is an executive at a pharmacy benefit manager (PBM) in the work comp industry. I started the article with a little bias and hesitation. If you work for a PBM, your main concern centers on prescriptions — reimbursement and cost. After suing a different PBM several years ago, I developed a healthy degree of skepticism as to whether drug payers are really interested in patients. I don’t say that to judge the author or his company.
I will say this author begins with the right issue. He points out that as opioid prescriptions decline, providers and payers have not embraced other treatment modalities. That is an important issue for injured people suffering chronic pain. We must address and treat hurting people. The author then discusses several alternative medication therapies. I represent many injured workers facing chronic pain. So, the discussion of alternative treatments peaked my interest.
Medication therapies are important. So are non-medicinal treatments.
I think the article’s author misses the broader picture. For the broader picture, I would look at insurance company behavior during the entire process and ask how that behavior can prevent the onset of chronic pain conditions in some cases as well as properly treat patients suffering genuine chronic pain.
Work Comp Insurers Contribute To The Development Of Chronic Pain Conditions
How can I say the insurance company helps cause chronic pain? After all, the insurance company did not cause the accident. The insurance company entered the picture after the accident.
I’ve helped injured workers in Alabama for over two decades. One of my recent cases is a perfect example. In that case, a trucker suffered a serious shoulder injury. After the accident, the worker could not move his arm. He needed an MRI. Yet, the insurance company refused. During the long delay, his injury and pain continued to worsen. The doctor begged for MRI approval. When finally approved, the MRI revealed a serious tear and the doctor promptly recommended surgery. Again, the insurance company initially refused. The patient suffered a clear shoulder tear that warranted surgery. Instead, the patient waited for months, worsening and developing increasing pain and depression.
The insurance company finally approved the requested surgery. After surgery, the insurance company continued to deny helpful rehabilitative care. Several different doctors grew frustrated and documented those frustrations with the carrier. Meanwhile, the patient could not recover. Instead, he progressively worsened. This patient could have easily been rehabilitated.
Is my case an isolated incident? No. I see this behavior over-and-over. In many cases, chronic pain develops when injuries are not treated and rehabilitated in a timely manner. When the insurance company meets valid medical requests with refusals, delays, or simply silence for long periods, patients can experience progressive debilitation. Conditions that could have been repaired become chronic and permanent. A mindset focused on short-term savings creates a huge long-term cost. That’s exactly the problem — An insurance company looking at short-term costs or savings instead of the very real (and huge) long-term costs. That shortsighted behavior will not change unless we structurally change our workers’ compensation laws.
Work Comp Insurers Leave Chronic Pain Patients Untreated And Unhelped
The author also reports attending a conference and overhearing an industry professional question why they would pay for other treatment when “pills are so much cheaper.” Maybe that’s the problem! In some cases, insurance companies view pain pills as a cheap alternative. As I stated earlier — A mindset focused on short-term savings creates a huge long-term cost.
The author then discusses several non-opioid medication alternatives. He has some good points. I’m looking forward to part two of his post. He promises to write about non-pharmaceutical alternatives. That’s a much needed discussion.
Here’s what I see far too often — A injured worker develops genuine chronic pain. That chronic pain needs treatment. With a little treatment, the injured person could probably rejoin the workforce in some valuable capacity. The person would likely function better in every capacity — at home, at work, in the community.
Instead of real treatment, the insurance carrier ignores the pain problem. Assume the patient had surgery and is still experiencing some level of real and chronic pain. Often, the insurance carrier simply sends the patient back to his / her surgeon. They may have the best surgeon in the world. But, surgeons are usually not the best option for rehabilitating or managing chronic pain patients. Nothing happens. The surgeon has nothing else to offer within his / her specialty. So, the patient is at a dead-end. In some of these cases, the insurance company will send the patient to a local rehabilitation doctor. Yet, the insurance company frequently limits these referrals to a one-time visit so the rehabilitation physician can assess physical restrictions, safe limitations or an impairment rating. In other words, no treatment. No real help for the patient. No further medical costs for the insurance company.
In Huntsville (and elsewhere in northern Alabama), we have some excellent rehabilitation doctors. These doctors are trained to use different non-surgical modalities to treat chronic pain or disability. I’m talking non-opioid treatment that can help. Authorize them to provide real treatment. Some insurance companies opt against authorizing care because of cost. Yet, the cost of periodic rehabilitative care is minor in comparison to the huge cost of disability, suffering and unemployment in untreated patients.
Unless Alabama amends its work comp laws, insurance companies will continue to deny or delay basic care. We need to give our injured neighbors the ability to enforce work comp laws and to stop wrongful delays in treatment.
At the Blackwell Law Firm, we represent injured workers across Alabama. We have tried workers’ compensation cases in courtrooms across the state.