What you can do if your health insurance plan denies coverage for the IPCA Chronic Pain Program behavioral pain medicine evaluation.
If you are a candidate for the Integrative Pain Center of Arizona (IPCA) Chronic Pain Management Program your IPCA doctor will request behavioral pain medicine evaluation and testing for you. This is the first step of the Chronic Pain Management Program.
You may find that your insurance company denies coverage for the behavioral pain medicine evaluation. This would mean that your insurance has denied you access to the Chronic Pain Management Program. The following information is intended to help you understand why insurance companies deny coverage for the behavioral pain medicine evaluation, and on page 2 we have included a letter fom us, for you to use when communicating with your health insurance company.
Insurance companies deny coverage for the IPCA behavioral pain medicine evaluation and testing for two reasons:
- The insurance company staff misinterpret the service as “mental health services”. Once they make this mistake, you will be denied insurance coverage either because:
- Your plan does not have a mental health benefit
- The IPCA psychologist is not contracted as a provider of mental health services you’re your insurance company.
You can help your insurance company understand.
The behavioral pain medicine evaluation, testing and treatment that your doctor has ordered is pain treatment, not “mental health” treatment. Your insurance company may need your help understanding that the IPCA psychologist will be treating a medical condition, not a mental health condition. A good analogy would be: the counselling patients in cardiac rehabilitation programs recieve – it has nothing to do with mental health – it is about changing behaviors.
The behavioral pain medicine evaluation, testing and treatment that your doctor has ordered is evidence-based medical practice – there is research to show that this evaluation is needed.
Your doctor has already made it clear in your clinic notes that you are NOT being referred for mental health services, and your insurance company has these notes. The information that you are reading right now is available on line to your health insurance plan representative, 24 hours a day. This is often not enough, but it is all your doctor can do.
Click here to view a letter to an insurance company that has denied coverage for behavioral pain medicine services. You can print this letter and use it to help educate your insurance.