STEPPING OUT: Carolyn Ward of Newcastle West is worried health insurance changes will limit access to services for her chronic pain device. Picture: Simone De Peak. FOR Newcastle West’s Carolyn Ward, 64, federal reforms to private health insurance suggest more pain on the horizon.
Ms Ward saystwodecades of back and leg pain, related to arthritis, made her rethink “every aspect” of her life, from her to ability work and lookafterher grandchildren, to takingtrips to the beach.
“It eventually got to the point where I couldn’t walk very far, couldn’t sit for long periods of time, couldn’t stand for a long period of time,” she said.
“I just rocked back and forth because the movement would help the pain.”
Ms Ward is one of a “very small” percentage of ns with chronic pain who usea device implanted into thebody to manage symptoms.
She saysthe surgical implantation of an electrical device, called a neurostimulator, was “life changing”.
Ms Ward was able to afford the procedureusing her top-levelhealthcover.
Under changes made to private health insurance by the federal government this month, “pain management with a device” is set to become theonly form of pain managementnot coveredas a requirement of mid-range hospital policies.
Insurers will be requiredto cover the devices intop-level, or “gold tier” policies, but will be able todecidewhether devices are covered bycheaper “basic”, “bronze” or “silver” polices.
Dr Chris Williams
According to thenew rules, allother forms of pain management will becoveredby bronze, silver and gold policies.Insurers have until 2020 to applythe changes.
Ms Ward is worried the reforms will jeopardise her ability to claim formaintenance or replacement of her device in years to come.
Her doctor, Newcastle-based pain specialist Dr Marc Russo,who is also the director-at-large of the Neuromodulation Society of and New Zealand, has been campaigning for cover to be expanded to bronze and silver policies.
Pain , the peak body fororganisations in the pain sector, has “welcomed” the reforms.
“The vast majority of those with chronic pain will have similar access to pain management services,” Carol Bennet, the chief executive officerof Pain , said.
“It also means it will be clearer and more transparent for those dealing with insurers.”
Ms Bennett said the “next discussion” that needed to be had with insurers was making sure thoseaccessing devices on lower-cost plans continued to be able to do so.
“Those procedures are costly, but not always. They have been known to be available in [the equivalent of] bronze and silver policies.”
Dr Chris Williams,research fellow at the University of Newcastle’s School of Medicine and Public Health, said he supported the placement of devices in the highest level of cover.
“It’s early days for these types of devices,” he said.
“There are lots of patents on these devices but there are very few high-quality trials which show that they are effective.
“There is some evidence, although not very recent, that such devices have a high rate of adverse events.”
Dr Williams,who also leadsthe musculoskeletal program at Hunter New England Population Health,said governmentpolicy shouldprioritise access to “multi-modal” care for chronic pain.
He referred tointerdisciplinary clinics, like the Hunter Integrated Pain Service, whichbring together pain specialists, physiotherapists, psychologists and other supports.
“According to the research that’s available, that is what is effective for patients, and it’s cost effective as well.”
ACTIVE AGAIN: Carolyn Ward of Newcastle West is worried health insurance changes will limit access to services for her chronic pain device. Picture: Simone De Peak.
Ms Bennett estimated the number of ns with chronic pain using a device to manage symptoms was“very small”, between twoto fiveper cent.
Data from nib Health Fund showed that 308 of their members had a hospital episode forpain management with a device last year, compared to 1,311 members admittedforpain management without a device.
“It’s a very limited treatment option for people who have tried most other things,” Ms Bennett said.
Ms Ward said that was why she wanted to be sure she could continue accessing services for her device.
“I don’t want to have to go back to what I was experiencing before,” she said.
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