When insurers don’t pay, patients receive only temporary relief

Holly Hodge

Private insurance companies are unwilling to cover cutting edge medical procedures in the pain management field. This limits care options for patients and perpetuates the treatment of symptoms rather than the root cause for patients seeking help. I shadowed a pain management doctor for a week and saw this issue first hand, with all but only one of the forty patients I met unwilling to try a procedure that was not covered by insurance.

One such noninsured procedure used in pain management, called PRP (platelet-rich plasma), involves taking a few ounces of a patient’s blood, spinning it down in a centrifuge, removing the platelets, and reinjecting the platelets into the damaged area of the body, such as a facet joint along the spine. Some people will also reinject their own stem cells or the stem cells from umbilical cords along with the PRP to also aid with healing. The platelets prompt the body to use its natural healing processes to work in the region in which the platelets are injected. This procedure has been around for a few decades and has been used by famous athletes such as Kobe Bryant and Tiger Woods to increase the rate of their healing after an injury.

Despite PRP’s widespread use, insurance companies aren’t willing to cover it because they claim that there is not enough research to conclusively show PRP’s benefits. However, they are willing to cover painkillers such as opioids which only offer temporary relief and commonly lead to addiction and overdose. These opioids resolve some pain for patients but do nothing to heal the underlying problem that is the cause of the pain. Opioid addiction is a rampant problem in the United States with 28,647 deaths attributed to opioid overdose in 2014. There are minimal to no risks with PRP since the procedure only involves the reintroduction of cells already produced in the body.

Invasive procedures such as steroid injections, which are covered by insurance, help to reduce pain but do not permanently resolve the pain itself. PRP offers hope to patients since it can offer a long lasting and even permanent solution to damage in the body. At some clinics PRP can cost upwards of $1,000 per injection and usually must be done a few times  for the best results. Most Americans don’t have the resources to spend that much money to alleviate their issues even if it would drastically improve their quality of life.

Evelyn Salcedo, a certified medical assistant who works in a pain management clinic, works for a pain management doctor by recording1 patient information when a diagnosis is made and taking the vitals of patients. She said that she thinks insurance companies won’t cover PRP because it’s considered “regenerative medicine” and there will be a flood of patients wanting the procedure if insurance companies covered it.

“Insurance companies don’t have the right to not cover certain procedures,” Salcedo said. “They are making it harder for the people who are in legit pain to obtain a happy and normal life.”

The lack of support from insurance companies incurs a moral issue of what an insurance company's job is, whether it is to help their customer as best they can or to make a profit.

Hodge is a neuroscience sophomore from Austin.