Dear Patients:

2021 is already stacking up to be a complicated and frustrating year for patients with chronic pain and the doctors who attend them. Long story short, more and more insurance companies have hired outside consultants to oversee the costs of your pain management. If your health insurer has hired one of these consulting companies, your personal pain management plan is under that company’s review. Their staff looks at what your doctor (me) has planned for you at your next appointment, and recommends approval or denial. Your insurer has the final say, but I think it is safe to assume that if the consultant recommends refusal of treatment authorization, your insurer will go along with that decision.

Our staff has already spent hundreds of man hours on the computer and on the phone trying to keep your treatment in place in the face of this new policy. As doctors, we’ve had conference calls and a Zoom meeting with one of the major consulting companies, trying to understand what we have to do on our end to keep treating you as effectively as we can. I’m sorry to say that previous treatment success alone means little or nothing nowadays. It doesn’t matter if you and I have figured out, through many appointments together, that a certain injection combination keeps most of your pain to a minimum for most of the time between visits. The consulting company has its data about what statistically works or doesn’t work for a patient with a given diagnosis, and that data is what determines if you’ll be covered for one or all or none of the injections I’ve planned for you. How you yourself happen to do with your personal treatment combination just doesn’t count if the consulting company data says that your personal treatment combination, statistically, won’t help you.

Please understand that this is out of our control. There are going to be cancelled appointments. There are going to be appointments when you arrive expecting an injection but won’t be able to get it unless I do it entirely for free or you pay entirely out of pocket. You are going to have to come in on two or three separate days to get the injections you previously got at one visit.
I’m going to be told that because I failed to document X or fill out Y, I can’t proceed with what I’ve planned for you. And so on.

To be fair, I am quite sure that there are pain specialists who have taken unfair advantage of the “carte blanche” we enjoyed for many years. I’d like to think that those doctors are not at MPC. Over the years, we have compile data on over 100,000 patients with chronic pain who have been treated at MPC-affiliated practices. I always felt that the data was very impressive. Others believed the same, I might add. Until just a couple of years ago, we were in fairly advanced discussions with one major insurer to have patient treatment fast tracked based upon our record of performance. Essentially, patients would come to us from referring doctors pre-approved for whatever treatment the MPC doctor felt would be most appropriate, so long as we maintained the same standard of care that had brought about consideration for such a policy in the first place. We’ve not changed our style of practice, so I can only assume that the decision to kill that program has been based upon financial concerns.

If you have a Blue Cross affiliated insurance (Blue Care Network, Medicare Plus Blue, Blue Cross, etc.) you are already feeling this. If you have Meridian or Molina Medicaid, you are already feeling this. The same goes for Aetna and United Health Care. As for if/when other insurers will follow suit, I wouldn’t try to predict; things are changing very rapidly nowadays.

I’ll be the first to say that I don’t do well with change like this in my professional life, and probably elsewhere as well. I like having some consistent anchor points in my days, and I like feeling that I have backup. For many years, I had that backup. I sort of felt like there was a tacit agreement between specialists such as myself and the insurance companies. If I were willing to take on chronic pain, the disease that almost no other doctors want to take on, I’d be allowed to do what needed doing, and would be reimbursed for it. I’m proud to say that I never took that backup for granted when I had it. To this day, I really cannot tell you any specifics as to what I’m paid for performing a given consultation or procedure. It just shouldn’t matter. If you, may patients, have honored me by placing your lives into my hands, I must reciprocate by never, ever, doing anything that places money above your well-being. Over the years, that principle has woven itself into my fibers, and has become an inexorable part of my personal code. I’ll quit before I violate that code.

For now, though, quitting is an option for neither you nor me. You have your pain, and I have my medical practice, and the two must endure, adapt, and overcome what we now face. Stress levels are higher, and may well intensify. At times, I can actually feel the increase as I work through my day. When that happens, I try to remind myself that I’m not alone. I know for a fact that doctors in some other specialties are feeling it, and when I meet with them, we try to bolster one anther rather than just complain, and that helps. But I have even better support much closer to hand. I am fortunate to have a great staff, both on the business end and the office end of this enterprise. These folks are looking out for us, you and me, by trying to find options and alternatives, quite often on the fly. You don’t get to see much of the business people, but I do. The one good thing that has come out of this situation is that I am now much more aware of just what it takes to get you treated, get my paycheck wired to my bank, get the clinic doors opened for the doctors and the patients early each morning, without fail, well staffed and well stocked. It is a logistical feat.

As for the office and medical staff you see at each appointment, as I’ve said before, I’ll stack them up against any other practice’s. Truly, the only thing I can personally do to reciprocate for their efforts is to do my best to make them feel appreciated and valued, and I ask you to do the same. They are here for both of us, and without them, we’d be lost.
I’ll try to keep you posted on the changes that will affect you, as well as what MPC is trying to do on your behalf. May I leave you with one last request? Make your voices heard. Sooner or later, we are all patients, and what you have to say matters a good deal more than what I might have to say. The newspapers and news programs, the internet sites, our elected officials, and the insurance companies themselves need to hear from you, the person seeking relief from (and trying to live with) chronic pain.