A chronic pain management program provides coordinated, goal-oriented, interdisciplinary team services to: reduce pain, improve functioning and decrease the dependence on the health care system by the member with chronic pain. The goals include providing the tools to manage and control their pain and thereby improving their ability to function independently, not the elimination of all pain
Prior Approval is required.
Benefits for an Outpatient chronic pain program are limited to those programs that have achieved accreditation by the Commission on Accreditation of Rehabilitation Facilities (CARF).
Before benefits will be allowed for an outpatient chronic pain program the following guidelines must be met:
Benefits will not be allowed to an outpatient pain program if the patient:
Benefits for an Inpatient chronic pain programs would be medically appropriate and necessary when:
Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information.
If a program is not accredited, reimbursement will be made only for the individual components of the program that are medically appropriate and necessary for the condition and a covered benefit under the member’s plan
Reimbursement for follow up care will only be allowed for those services that are determined to be medically appropriate and necessary.