Do Insurance Companies Make It Easy or Hard to Treat Lower Back Pain with Physical Therapy?

A recent study conducted by the Journal of the American Medical Association, that recently was reviewed by APTA, looked at how often and easily insurance companies made it possible to use physical therapy as a course of treatment for lower back pain. The idea was to look at alternatives to opioid prescription use.

“The study, published in JAMA Network Open, looked at 2017 data from 15 commercial, 15 Medicaid, and 15 Medicare Advantage (MA) health plans in 16 states…Researchers were interested in the degree to which insurers were covering nonpharmacological treatments for LBP and, if so, what restrictions they were placing on that use…The study focused on 5 nonpharmacological therapies for LBP across all plans: physical therapy, occupational therapy, chiropractic care, acupuncture, and therapeutic massage. Additionally, because the information was readily available through Medicaid, researchers added 6 more approaches to their review of Medicaid plans: transcutaneous electrical nerve stimulation (TENS), psychological interventions, steroid injections, facet injections, laminectomy, and discectomy.”

The Good – Physical therapy was almost always considered a medical necessity and was thus covered by insurance. “Of the commercial insurer coverage policies reviewed, all included physical therapy.”

The Bad – Unfortunately, ease of access was uneven. “Among the 15 commercial insurers studied, researchers found 1 instance of prior authorization requirements, 10 instances of limits put on visits to a physical therapist (PT), and 1 instance of a referral requirement.”

Co-pay requirements were also all over the map.

The Ugly – While insurance companies aren’t making it impossible to treat lower back pain with the often preferred multi-prong approach, they are leading the horse by the wrong end. “Innovative strategies to combat the opioid epidemic…tended to center around improved formulary management of opioids, substance abuse treatment, and identification of opioid over-users and over-prescribers” with far less emphasis on “optimizing coverage and access to nonpharmacologic therapies for chronic pain.”

“Despite a growing evidence base supporting the effectiveness and cost-effectiveness of many of the nonpharmacological treatments examined in our study, our findings depict inconsistent and often absent coverage for many of these treatments.”

If you’d like more information about physical therapy continuing education resources, including methods for treating lower back pain, please visit CEU Market.


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