The Influence of Insurance on Clinical Results

Low back pain (LBP) from a disc problem occurs in patients no matter what insurance coverage they have. But diagnosis and treatment may be based on their insurance coverage.

This study compares patients with LBP in two groups. One group had been in a car accident. They could see any doctor they chose under a personal injury program (PIP). The second group had a work-related injury. They were managed under a worker's compensation (WC) program. The WC group sent patients to a group of approved doctors.

In the PIP group, treatment and reimbursement depends on getting approval for treatment in advance. This is called preauthorization. In cases of lumbar disc problems, this approval often depends on the patient having a positive straight leg raise (SLR) test. The SLR test is a reliable test. A positive SLR test on one side is called unilateral SLR. A positive SLR test on both sides is a bilateral SLR.

A review of 200 patient charts was done. A higher percentage of people with a positive SLR was seen in people covered by a PIP than by WC. Here are the results:

  • A positive SLR (unilateral or bilateral) was 7.4 times more likely for women covered by a PIP.
  • A positive SLR (unilateral or bilateral) was 23.5 times more likely for men covered by a PIP.
  • A positive bilateral SLR was 105 times more likely for woman covered by a PIP.
  • A positive bilateral SLR was 39 times more likely for a man covered by a PIP.

    The authors say it's possible that patients in the PIP group had a more severe disc problem compared to the WC group. However, there wasn't enough proof of this when the charts were reviewed. Researchers aren't sure why such big differences were seen between the PIP and WC groups.

    It could be that PIP patients are looking for a money settlement. But since the same could be true of patients in a WC program, it's probably not the reason for the difference. It's more likely that doctors report findings inappropriately. The doctor's goal is to get insurance approval so the patient can get more care.

    Other reasons for the differences seen in this study are suggested. The authors think the results show the need for more studies in this area.



    References: Scott F. Nadler, DO, et al. Positive Straight-Leg Raising in Lumbar Radiculopathy: Is Documentation Affected by Insurance Coverage? In Archives of Physical Medicine and Rehabilitation. August 2004. Vol. 85. No. 8. Pp. 1336-1338.

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