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Based upon Marketdata's research and surveys of chronic pain programs, the single most critical problem facing chronic pain programs continues to be reimbursement and third party approval by insurers. A total of 42.5% of the total group stated that this was the number one issue. The second most important problem mentioned is that there are too many unqualified practitioners in this field, or an increase in the number of poorly trained practitioners.Here are other issues that were mentioned:
payor understanding of the importance of uninterrupted treatment, its impact on success disagreement over use of narcotics/medications unethical and fraudulent practices by insurance carriers Percentage of pain management patients that are covered by/pay by… 2003 2001 1999 cash (out-of-pocket) 2.9 % 2.2 % 5.2 % Medicare 33.8 27.0 40.4 auto no-fault insurance 2.2 5.0 NA HMO/PPO plan 22.5 23.7 21.8 Medicaid 7.9 12.0 7.2 private, full-indemnity insurance 17.9 15.6 12.9 workman’s comp insurance 11.5 14.5 12.5
The procedures or pain relief techniques most commonly denied by insurers include the following:
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Source: Marketdata Enterprises, Inc., Chronic Pain Management Programs: A Market Analysis
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