Pain & Psychotherapy

[Snuffalufugus]

Hi all,

No, I'm not a doctor, or even in medical school. I am taking pre-reqs for nursing, so I'm "somewhat" in the "medical field," or at least will be in the future. I read your boards often and with interest, and wanted to post a quick question.

Many of you have commented that there is an absolute psychological component to chronic pain. I agree completely. I have had chronic back pain for several years. I have been seeing a psychologist for the past year. She has helped me significantly. However, my insurance - which is fabulous in every other aspect - only covers 75% (which sounds great) UP TO $71.53. Every visit costs me $170. Therefore, insurance covers $53.65, or 31.6%. That's low. I find this component of my multi-disciplinary care to be extremely important and useful, but it's costing me. I'm lucky that I can afford it. Many in my shoes would not be able to. If more were covered, I would go more often (currently go about once every 3 weeks).

I realize that I am one of your dreaded patients - the chronic back pain patient - so you may just dismiss me, but I thought the question was worth asking anyway: what are your feelings on most insurance's pathetic coverage for psychotherapy? Should they pay more? If so, should they pay less for something else (prescription drugs, diagnostic studies, routine office visits...)? Just curious what your thoughts are. Just wanted to put that up for discussion. I'll fade back into "observation mode" now.

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[drusso]

Snuffalufugus,

I think that most pain physicians would agree that psychotherapy and mental health treatment should be better compensated than what it is. Unfortunately, that is not the case. There are a variety of reasons for this both economic and systemic.

For now, the best approach to a remedy is broad federal legislation and policy to address mental health parity. Write your Congressman.

 

[PMR 4 MSK]

They should have a provision for chronic pain exceptions, which they don't, by and large. Many of my patients cannot afford the psychotherapy they need. I cannot provide it. Therapists are less willing to work for free than most doctors.

Maybe if they paid less for opioids to disincentive that arena it would allow for more money for psychotherapy. But for how long should they pay for it? How many visits?

An extreme example is Medicaid, it often will not pay for PT, injections, counseling, etc., but will cover humongus doses of pain meds. Purely idiotic policy.

 

[Aether2000]

1. Consider finding a psychologist in your network. That may avoid paying the very high fees being paid.
2. At that rate, the psychologist is bringing in well over $300,000 a year take home if the slots are all filled. That does seem like a lot of money to be paying for psychiatric care
3. Psych is an important part of chronic pain and psychology is an important treatment modality, however insurers do not value their services as much as the psychologists do. But, the health care system cannot continue to sustain double digit increases in costs every year, and if insurance paid for psychologists for the 80% of the population psychologists consider to have psychiatric conditions, the system would be rapidly bankrupted.