COMMENTARY: Health insurers help drive the opioid abuse problem

Missing from legislation designed to combat Nevada’s “opioid crisis” is any attempt to address the complicity of our state’s medical insurance companies. As a pain medicine specialist with 29 years of practice experience in Southern Nevada, I can attest that many medical insurance companies systematically delay or deny interventional pain treatments and that these delays contribute to the use of opioid analgesics.

It’s really quite simple — medical insurance companies design policies that delay or deny care in order to maximize company profits with no regard to optimal patient care.

Chronic pain is problematic because of its inherent physiology — deeply embedded, poorly understood brain circuitry akin to memory — and, as such, is difficult to treat. Chronic pain can make routine daily tasks difficult and difficult tasks impossible, impeding employability, upending families and creating severe personal and societal stress. Pain medicine physicians attempt to diagnose and treat acute or subacute pain before it becomes chronic. It is scientific fact that prompt and effective acute pain treatment prevents chronic pain.

But pain medicine procedures have associated costs, and these costs conflict with the medical insurance companies’ primary motive — profit. By denying indicated medical procedures, an insurance company retains more subscriber money to invest for profit. These companies then use their profits to pump up their own stock, provide executives handsome bonuses, lobby lawmakers and pay for advertisements. Each day that a procedure is delayed or denied by the insurance company, more money is available for profitable investment.

Sadly, the goal of the medical insurance industry is exactly opposite to the goal of the subscriber/patient. While the subscriber pays the insurance company money for access to medical care, the insurance company actively delays or denies care in order to use that money to maximize company profits.

I recently cared for a woman with a three-month history of right lower back pain that had failed to improve with rest, physical therapy and over-the-counter medications. Two diagnostic interventions identified her pain generator as the right L5S1 facet joint. But, rather than promptly eliminate the pain with a state-of-the-art standard-of-care treatment, her insurance company denied the procedure. This denial resulted in multiple correspondences between the patient, my office and the insurance company.

Finally, I was able to have a telephone conversation with the insurance company’s “medical director” (a doctor bought and paid for by the company). If, as expected based on the clear-cut medical indication, the procedure is finally “approved,” my patient will have suffered an additional two months of severe pain. The delay will have caused my patient to consider the use of an opioid analgesic. Adding insult to injury, the insurance company has structured its medication formulary such that only the most problematic opioids (those without abuse-deterrent properties) are financially feasible.

In summary, the self-serving policies of this insurance company pressured an innocent patient to consider needless exposure to an opioid medication. And this happens multiple times in multiple pain medicine practices every day throughout the Las Vegas Valley.

On my first day of medical school, an esteemed Harvard professor expressed his opinion regarding medical insurance companies, noting that the tallest buildings in most major cities were named after such companies. As he said, “Insurance companies can’t build skyscrapers by putting the welfare of patients first.”

I would advise our governor and state legislators to take a good hard look at medical insurance company policies that interfere with optimal pain treatments. Allow Nevada’s pain medicine specialists to utilize their expertise to minimize pain and, therefore, minimize the use of opioid medications. And when opioids are necessary, make abuse-deterrent formulations affordable.

Legislation should ensure that Nevada’s medical insurance companies put patient care above company profits.

Michael J. McKenna, M.D., is the founding member of McKenna, Ruggeroli and Helmi Pain Specialists. He is the former president of the Nevada Society of Interventional Pain Physicians.