Expanded coverage brings more patients to Pain Center

June 14, 2009
| By Pete Daly |
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Restricted health care coverage for psychological services used to put a cost burden on chronic pain patients, which discouraged some from seeking all the help available at The Pain Center at Mary Free Bed Rehabilitation Hospital.

Those limitations are easing now, much to the relief of The Pain Center staff — and to patients like Paula Limburg, a retired Lansing-area Christian schools principal and teacher who has suffered with chronic migraine headaches for 12 years. Last year, after retiring in June, she sought treatment at The Pain Center, an adult outpatient therapy program that served about 150 patients last year. At that time, her treatment, which lasted several weeks, required her to pay almost $3,000 out-of-pocket, because her insurance only covered 50 percent of some psychological services, and zero for others.

This winter she suffered an unrelated illness that triggered a resurgence of her migraine pain, so she is returning for additional treatment. But this time her insurance will cover 90 percent, since the adoption of new insurance codes.

Her treatment is in three parts. “I see a physical therapist who manipulates my neck and shoulder muscles," and who also instructs her in physical stretches she can do at home to relieve stress. The other two parts of her treatment include the services of a psychologist and a medical doctor. "They're kind of attacking it from several points of view," she said.

The attempts to deal with her chronic pain "have been expensive for me for the last 10 years, and migraines are such a hard one to deal with," she said. Medication is "always a problem for migrainers," said Limburg, because if the pain is chronic and severe, the inclination is to take prescription medication every day “and that is not a good answer in the long run."

Edmund O'Connor, director and chief psychologist of The Pain Center, said theirs is an "intensive program — six to 12 weeks."

According to The Pain Center Web site, pain can put a person's life on hold: "Pain treatments such as surgeries, medication and rest may have become your priority. This leaves no room for family, friends, church, work, or recreation."

The Pain Center takes a rehabilitation approach that targets improvement in the areas of life one values the most. It teaches its patients skills to respond differently to pain — reducing it as much as possible and managing the rest. The staff includes specialists in the areas of medical, nursing, psychological, and physical and occupational therapy.

"Because of the intensity of treatment," said O'Connor, "patients will come two, three times a week, sometimes seeing psychology, for example, twice a week." If the patient's insurance only covered 50 percent or it, or didn't cover the biofeedback at all, for example, "that can run up into a bill of a thousand or more dollars.

"And that would prevent a lot of people, particularly in this economy, from coming in for treatment.

"Biofeedback is a very important component of our treatment within psychology," according to O'Connor.

He said biofeedback refers to use of electronic equipment that measures a patient’s arousal level in response to pain and/or stress. The response can make the pain worse; patients with low back pain, for example, may tense their low back muscles, guarding and bracing that area of their bodies while standing or moving.

"We use biofeedback to measure the muscle tension in that area," he said. "Then we use the feedback to increase (the patient's) awareness of the tension and teach relaxation techniques to reduce it, often relieving some discomfort."

He said they frequently see cold hands in patients with migraine headaches, "a sign of heightened arousal as the blood doesn’t get to their extremities. We can measure fingertip temperature on the computer and as a patient relaxes, the computerized graph will show the increase in temperature. This improves control over the body and a sense of mastery. In turn, headache frequency and intensity often decrease because of the improved circulation."

Stress can often be detected in shoulder tension, he said, which can also be measured. Patients are taught to recognize that tension and relax it, decreasing neck and shoulder pain and headaches.

"Often this (biofeedback) service wasn’t covered," said O'Connor. "Many patients had to skip this part of treatment or pay out-of-pocket. It is now covered under the H&B (Health & Behavior) codes (that apply to psychological services), and everyone who needs it can now receive this."

All insurance companies designated as Medicare Administrative Contractors have reimbursed for the health and behavior assessment and intervention codes since 2006. As of January, more than 50 private health plans now also pay for these treatments.

O'Connor said there has been a tendency in the health care insurance industry to separate psychological from medical treatments.

"Right away that becomes a problem, because people are mind and body together," said O'Connor. He noted, for example, that cancer usually entails emotional problems too.

"If you have chronic pain, there are emotional factors that can add to the physical experience of the pain, and the coping with it afterwards.

"We would have to carve out a mental health diagnosis in order to use psychological benefits, which often have higher co-pays or limited sessions," he added.

Chronic pain can be debilitating, changing a person's focus in life, said O'Connor.

"The definition of chronic pain means it's not going to go away — so we take a rehabilitation approach" to treating the patient, he said. That includes training the patient, much like the way professional athletes are trained to deal with and overcome the pain from injuries that can limit their performance.

With these new codes, the insurance companies are recognizing that psychological services have a place in medicine, according to O'Connor, "and you don't need a psychological diagnosis."

"This is a huge step forward in uniting psychology with medical practice," he added.

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