“Experimental Treatments” for Lumbar Disc Herniation and Degenerative Disc Disease (according to the insurance industry)

I want to tell a little story of a patient I had about a year ago.  He came to me with right sided sciatica and his right buttocks was completely numb.  He had mild weakness but no foot drop in this extremity.  The MRI results (see attached)     showed a very large disc bulge at L5/S1 level and I felt the patient would need surgery.  He was adamant about avoiding surgery and wanted to try everything else possible before “going under the knife”.  I sent him to a neurologist for and EMG (nerve study) that came back with only minor nerve damage so we went ahead and began a series of spinal/core strengthening exercises and physical therapy modalities.  We went for 2 weeks with no or little improvement.  At this time he made the decision to begin IDD therapy (non-surgical spinal decompression).  The therapy is typically 20 to 25 treatments and also incorporates myofacial release (soft tissue mobilization, physical therapy modalities, neuromuscular re-education, and spinal stabilization exercises (all of which were attempted prior to the IDD therapy and failed to bring about results alone).  The patient’s care was tracked with an Oswestry Low Back Pain Disability Questionnaire and after 8 sessions the patient was 47% improved (see attached).  After 25 treatments over about 2 months the patient was 100% recovered according to the Oswestry Questionnaire results (idd-patient-oswestry.doc).  He was trilled and to be truthful we were both a little surprised with the results.  My point to this story is that the insurance industry, and quite frankly, many physicians feel that this therapy is experimental and without merit.  The studies are available and promising though not as extensive as some other therapies currently used to treat the same conditions.  In my clinic I have only had one patient who did not improve at least 75% after completing the IDD protocols.  About half of the treatment is covered with insurance but the IDD itself is not.  The question is “Why”?  The cost of this therapy is between $90 and $110 per treatment, which compared to the $35,000 to $50,000 for a surgical procedure is astronomical savings.  Why aren’t therapies that show promise covered by insurance?  Even with the $2000 to $4500 people may need to pay out of pocket for the therapy it is still cheaper than most people co-insurance responsibility for the surgery (anywhere from 10% to 20% depending on the individuals coverage).  This is just one therapy in many that are not covered and cause the patient more out of pocket expense.  Don’t we pay enough for our insurance coverage already.  I think my family premium is approximately $1000 a month and I maybe see the doctor once a month.  It just doesn’t seem like good business sense for the insurance companies not to pay for such therapies. They could even go to a program that demands that the “experimental therapy” provide at least a certain level of improvement or they would only pay a portion etc.  There are ways to make it work for everyone:  insurance companies, patients, and physicians.  Just a thought…