You May Be Eligible For a Chronic Pain Management Program for Your Lipedema

Here's a rundown of what the big insurance companies offer.

Photo by Gizem Nikomedi on Unsplash

As always, I offer embedded resources and tidbits in this post, so read to the end, you might find something helpful!

For many years, I was involved in a chronic pain management clinic. My migraines and body pains were unbearable. I had appointments every 6-10 weeks for occipital nerve block injections into my back and neck; I was referred to alternative care and given community resources for developing a plan of mindfulness, gentle movement, therapy, and whatever else I felt could benefit the management of my pain.

Over time, I’ve learned how to manage my chronic pain through prescription medications and alternative methods. I’m grateful for the efforts I received from my pain management clinic. Best of all, these clinic visits were covered by my insurance.

Many health insurance plans now offer chronic pain management programs as part of their broader disease management or wellness programs. These programs are designed to help patients manage chronic pain with coordinated care, access to specialists, and sometimes alternative treatments. Pain management programs work to avoid narcotic use to control your pain. Instead, they will focus on other medications, such as:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen, or naproxen 

• Muscle relaxants like baclofen or carisoprodol 

• Antidepressants like SSRIs or SNRIs 

• Anticonvulsants like gabapentin or pregabalin 

• Anesthetics like lidocaine 

• Corticosteroids like prednisone or methyprednisolone 

They also focus on other therapies to help manage pain, including: 

• Physical, behavioral, and psychological therapies 

• Lifestyle changes 

• Complementary or alternative medicine, like acupuncture 

• Massage 

• Weight loss regimen 

• Exercise 

• Yoga 

• Meditation 

• Physical therapy 

• Dietary changes 

The availability of these programs varies by insurance provider and plan type. If you are interested in joining a pain management clinic, look into your plan for their specific benefits.

How Do You Qualify For a Pain Management Program?

To qualify for a pain management program, you might need to meet the following criteria:

• Chronic pain

  You have chronic pain that's severe enough to impact your daily life, such as your social, vocational, or interpersonal activities.

• Duration

  Your pain has lasted six months or more, or there's a clinical indication that it will likely become chronic.

• Motivation

  You're motivated to use a rehabilitation approach to manage your pain. This often means you're aware that medical or surgical treatments aren't an option right now.

• Behavior

  You're able to control your behavior and aren't considered a danger to yourself or others. 

Some common conditions that people seek pain management for include:

• Arthritis

• Back pain

• Central pain syndrome

• Chemotherapy pain

• Fibromyalgia

• Headaches, Migraines

• Musculoskeletal pain

• Neck pain

• Neuropathy

• NOT Lipedema (but maybe this will change in the future?) Although lipedema may cause some of the conditions listed above.

You can schedule a consultation to see if you're a good candidate for pain management. If your primary care physician (PCP) or another specialist cannot help, you might also consider seeing a pain specialist. Depending on how your insurance plan is set up, you’ll be able to schedule a consult directly with the pain management clinic, or you’ll need a referral from your primary physician (check your insurance coverage rules and the criteria of the pain management clinic).

Here’s a list of the types of insurance plans that commonly offer chronic pain management programs:

1. Commercial Insurance Plans (Employer-Sponsored and Marketplace Plans)

• UnitedHealthcare: Offers a comprehensive chronic pain management program through its disease management services. Members have access to specialists, physical therapy, pain management clinics, and telemedicine services. Here’s a document of their benefits.

• Aetna: Aetna’s plans typically include chronic pain management resources under their care management services. They often provide personalized support for conditions like arthritis, fibromyalgia, and other chronic pain conditions. Here’s a copy of one of their medical policies.

• Cigna: Cigna offers chronic condition management programs, including for chronic pain. They provide resources for lifestyle adjustments, therapy referrals, and access to health coaches. Here is information on Cigna’s pain management program.

• Blue Cross Blue Shield: BCBS is a state-by-state plan, and each differs. Most offer pain management programs through their disease management services, helping members with conditions like back pain, arthritis, and fibromyalgia.

2. Medicare Advantage Plans

Although I would never recommend a Medicare Advantage Plan, some lipedema women are already on MA Plans. So, here’s a quick rundown:

• Medicare Advantage (Part C) plans, offered by private insurers, often include chronic disease management services, which can include programs for chronic pain.

• Many Medicare Advantage plans offer services such as physical therapy, pain management specialists, telemedicine, and sometimes alternative treatments like acupuncture or chiropractic care.

• Some plans, like those offered by UnitedHealthcare, Aetna, and Humana, may provide access to specific chronic pain management programs.

3. Medicaid Plans

• Medicaid plans are managed state-by-state and often include chronic pain management services. Coverage and program availability can vary widely by each state.

• Some Medicaid-managed care plans offer chronic disease management, which can include specialized care for chronic pain conditions.

4. Health Maintenance Organizations (HMOs)

• Many HMO plans offer chronic pain management programs as part of their coordinated care models. Because HMOs focus on primary care coordination, members often have access to referrals for pain specialists, physical therapists, and integrated care approaches.

• Kaiser Permanente: Known for its integrated care approach, Kaiser offers coordinated care for chronic pain patients, including access to physical therapy, pain management specialists, and alternative therapies. Here is the overview of their pain management program.

5. PPO Plans

• PPO plans may offer chronic pain management through a network of specialists, but members have more flexibility to see out-of-network providers. This allows for more freedom in choosing pain management specialists and alternative therapies, but typically at a higher cost.

• Large insurers like Blue Cross Blue Shield, Aetna, and Cigna offer PPO plans with access to comprehensive pain management services.

6. Telemedicine-Based Plans

• Many insurers now offer telemedicine services as part of chronic pain management. Telemedicine allows patients to access pain specialists, physical therapy, and mental health services (for conditions like anxiety or depression related to chronic pain) from home.

• Some telemedicine platforms, such as Teladoc Health or MDLIVE, work with insurers like UnitedHealthcare and Cigna to provide chronic pain management consultations and follow-up care virtually.

Features of Chronic Pain Management Programs:

• Access to Specialists: Many plans offer referrals to pain management specialists, including physical therapists, neurologists, and anesthesiologists.

• Alternative Treatments: Some plans cover alternative therapies like acupuncture, chiropractic care, and massage therapy.

• Personalized Care Plans: Chronic pain management programs often include personalized care plans that integrate medication, physical therapy, lifestyle changes, and mental health support.

• Health Coaching: Some insurers provide access to health coaches to help members manage pain through lifestyle modifications, exercise, and stress management techniques.

Also, you can use Zocdoc to locate an in-network provider for your pain management.

Many plans refer to Zocdoc to guide you to providers within their network. This is not just for pain management but for any provider you seek.

It’s important to review each plan’s specific benefits and call customer service to ask about chronic pain management options, as coverage may vary even within the same insurance company, depending on the plan.

I hope this helps!

Take care,

Michelle