The spine is the beam that holds our bodies upright, the solid frame of our anatomy. Without it, we would be unable to stand, move or be anything but a pile of matter. Back and neck pain affects 65 million Americans each year, and has been noted as the main reason for limited activity in young adults. Our nation has a very prevalent amount of serious spinal problems, as there are approximately 916,000 surgeries performed on this anatomic region every year. The majority of acute back pain occurrences stem from a muscular strain, which generally resolves itself over time. Muscular strain heals quickly, and it is simple to take preventive measures to avoid a true state of medical need.
For the most part, pain in the back and neck is a result of muscle strains, though it can also derive from worn joints, nerve compression, injuries and diseases like arthritis. Other sources of back pain (especially in the lower back) include lumbar disc herniation, degenerative disc disease, and isthmic spondylolisthesis in adults under age 60. For older adults, the pain may be caused by osteoarthritis, or another form of spinal disorder. Those who experience neck pain for longer periods of time may have a cervical spine condition, though it tends to be rare. When back or neck pain is chronic, a constant flow of over the counter and prescription medication, as well as chiropractor visits and physical therapy become routine. In very severe instances, a surgery may be necessary.
How Back & Neck Pain Affect Insurability: Past and Present
Health Reform and Back and Neck Pain
The implementation of the new healthcare law has been an immense help to anyone with a pre-existing condition by making it illegal to decline anyone for health insurance. This law is considered a landmark because of changing so many elements of our health insurance system: removing rescissions, ending discrimination against conditions, offering coverage to more people, especially those who need it most. Back and neck pain sufferers will no longer have to worry about being without insurance, or being charged too much or limited in coverage. Health plans on the individual market are also not permitted to block you from receiving condition-related benefits with an elimination rider or exclusion period.
The Affordable Care Act has also opened a new category of eligibility for Medicaid, by adding low-income adults without children in certain states. Before the ACA, and still in some states, low-income adults must have children or a disability in order to qualify, leaving millions uninsured. Acknowledging this limitation, the law gives more Americans the opportunity to acquire a health plan through public assistance. This may help a number of people with back and neck pain, as health conditions do not restrict themselves to people who can afford to treat them. Health insurance exchanges will also help people get some form of health insurance, as the government provides tax credits to reduce premiums for people with income over the Medicaid level up to 400 percent of poverty.
Because back and neck pain are so common, often muscle-related and easy to treat, health insurance were usually accepting of people who have mild to moderate back and neck problems. Those who suffered from a greater disease or used medications to treat recurring and ongoing pain did not receive such a smooth outcome. As these medications, even the store bought ones, contain side effects that can be ultimately detrimental when used is large, frequent quantities, it was a concern when health insurers were permitted to decline sick applicants. The main issue when assessing an individual for a health insurance policy was their current amount of health care costs, such as daily medication and future risks, such as a damaged liver from too much acetominophen. Chiropractor visits and physical therapy were also warning signs for insurance companies.
The amount of pain you experienced on a regular basis, how quickly it cleared up and what it could be attributed to were all of utmost importance when applying for health insurance before 2014. If you had a manageable condition or level of pain as opposed to a chronic illness, you would be treated almost like a normal (healthy) person by most insurance companies. If there is little need for medication, you were an even more appealing candidate. For those who did require even a regular dose of non-prescription medication, a large rate increase was likely to be in order, and a decline with certain insurers. Taking Advil or Tylenol may seem ridiculous to turn down for insurance, but they have their own health hazards.
Taking prescription pain killers and other medications for their back or neck was a major red flag, leading to decline in most cases. However, the majority of those with an occasional spasm, sprain, or strain, would not experience a great deal of adversity. Each insurer in each state was different, though applicants who used an expensive medication or health service on a regular basis had the highest odds against being approved. While insurance companies covered certain medications and even chiropractic care, they did not want to pay for them.
Featured below is one of the more lenient insurers’ underwriting guidelines from 2012, before the laws changed. While they were known for permitting many more conditions under their plans than other insurers, it did put its foot down regarding back and neck pain requiring medication. “D” is the stamp of disapproval, standing for decline. Applicants with muscular issues may have been able to make it onto the plan for a higher rate. Those with spinal problems such as herniated discs were also rated differently, many of whom would be declined, though some will experience a rate increase.
Health Plan Alternatives for Back & Neck Pain
Individual health plans are available to everyone no matter what condition they may have. The health care law also regulates premiums so they can’t get too high or offer too few benefits. There are several other options for health insurance besides what we sell here. The most common source of health insurance is available through the workplace, though the level of coverage varies and isn’t as closely regulated as the individual market. Medicaid and exchanges are also options if you have limited means and can’t afford a private plan, group or individual. Public assistance programs will never discriminate against anyone for having a condition, and they may offer coverage on certain medications and procedures. Here are a few ideas for health insurance coverage outside of the individual health insurance market, if you decide to look elsewhere.
Employer-sponsored health plans cannot decline a person coverage for their health, just like the individual market. Large businesses with more than 50 employees are also required to offer some sort of coverage, so if you work for a major corporation, read up on your employer’s policy. Whether your personal employer offers health benefits and you are eligible, or you have a spouse with access to insurance through work, you should be able to apply. Some employers do not allow spouses or family members on the group plan, however. Despite having a waiting period for approval, group plans will allow a person with back or neck problems onto their health plan. Group plans vary based on what the employer decides, though they should provide a comprehensive set of benefits for a reasonable cost. If not, seek out your individual plan options.
Medicaid & CHIP
People with back and neck pain whose income does not allow them to purchase a health plan may have the option of Medicaid, depending on their state laws. Medicaid will cover any treatment they feel is medically necessary and work with the special health needs of beneficiaries. In the majority of states, Medicaid is offered to adults with children, children under 19, pregnant women, and disabled and elderly persons. Certain states also allow low income adults regardless of having children or a disability, which makes plenty of sense. Check your state’s Medicaid guidelines through your local Department of Health for more detailed information. You can also ask one of our agents about Medicaid in your state by calling 888 803 5917.
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1. The Spine Foundation. “Spine Facts”. https://www.thespinefoundation.org/spine_facts/.
2. Mayo Clinic. “Back Pain”. http://www.mayoclinic.com/health/back-pain/DS00171.
3. Mayo Clinic. “Neck Pain”. http://www.mayoclinic.com/health/neck-pain/DS00542.
4. Spine-health. “Common Causes of Back Pain and Neck Pain”. http://www.spine-health.com/conditions/back-pain/common-causes-back-pain-and-neck-pain.