{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T02:03:23Z","timestamp":1783735403793,"version":"3.55.0"},"reference-count":40,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2019,1,1]],"date-time":"2019-01-01T00:00:00Z","timestamp":1546300800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Glob Adv Health Med"],"published-print":{"date-parts":[[2019,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>In 2017, the American College of Physicians (ACP) released guidelines encouraging nonpharmacologic treatment of chronic low back pain (LBP). These guidelines recommended utilization of treatments including multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction (MBSR), tai chi, yoga, progressive relaxation, biofeedback, cognitive behavioral therapy (CBT), and spinal manipulation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>We aimed to determine status of insurance coverage status for multiple nonpharmacological pain therapies based on the 2017 Essential Health Benefits (EHB) benchmark plans across all states.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The 2017 EHB benchmark plans represent the minimum benefits required in all new policies in the individual and small group health insurance markets and were reviewed for coverage of treatments for LBP recommended by the ACP guidelines. Additionally, plans were reviewed for limitations and exclusionary criteria.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In nearly all state-based coverage policies, chronic pain management and multidisciplinary rehabilitation were not addressed. Coverage was most extensive (supported by 46 states) for spinal manipulation. Acupuncture, massage, and biofeedback were each covered by fewer than 10 states, while MBSR, tai chi, and yoga were not covered by any states. Behavioral health treatment (CBT and biofeedback) coverage was often covered solely for mental health diagnoses, although excluded for treating LBP.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Other than spinal manipulation, evidence-based, nonpharmacological therapies recommended by the 2017 ACP guidelines were routinely excluded from EHB benchmark plans. Insurance coverage discourages multidisciplinary rehabilitation for chronic pain management by providing ambiguous guidelines, restricting ongoing treatments, and excluding behavioral or complementary therapy despite a cohesive evidence base. Better EHB plan coverage of nondrug therapies may be a strategy to mitigate the opioid crisis. Recommendations that reflect current research-based findings are provided to update chronic pain policy statements.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/2164956119855629","type":"journal-article","created":{"date-parts":[[2019,7,29]],"date-time":"2019-07-29T05:30:58Z","timestamp":1564378258000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":41,"title":["Analysis of State Insurance Coverage for Nonpharmacologic Treatment of Low Back Pain as Recommended by the American College of Physicians Guidelines"],"prefix":"10.1177","volume":"8","author":[{"given":"Robert","family":"Bonakdar","sequence":"first","affiliation":[{"name":"Scripps Center for Integrative Medicine, La Jolla, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dania","family":"Palanker","sequence":"additional","affiliation":[{"name":"Center on Health Insurance Reforms, Health Policy Institute at Georgetown University, Washington, District of Columbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8665-9679","authenticated-orcid":false,"given":"Megan M","family":"Sweeney","sequence":"additional","affiliation":[{"name":"Scripps Center for Integrative Medicine, La Jolla, California"},{"name":"School of Medicine, University of California San Diego, La Jolla, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2019,7,29]]},"reference":[{"key":"bibr1-2164956119855629","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)31678-6"},{"key":"bibr2-2164956119855629","unstructured":"National Centers for Health Statistics.\n                      Chartbook on Trends in the Health of Americans\n                      . http:\/\/www.cdc.gov\/nchs\/data\/hus\/hus06.pdf. Published 2006. Accessed May 25, 2019."},{"key":"bibr3-2164956119855629","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpain.2012.03.009"},{"issue":"2","key":"bibr4-2164956119855629","first-page":"21","volume":"88","author":"Katz JN.","year":"2006","journal-title":"J Bone Joint Surg Am"},{"key":"bibr5-2164956119855629","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.g6380"},{"key":"bibr6-2164956119855629","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2018.0236"},{"key":"bibr7-2164956119855629","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpain.2018.04.004"},{"key":"bibr8-2164956119855629","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2018.0235"},{"key":"bibr9-2164956119855629","doi-asserted-by":"publisher","DOI":"10.1186\/s12875-017-0608-2"},{"key":"bibr10-2164956119855629","doi-asserted-by":"publisher","DOI":"10.3122\/jabfm.2017.06.170061"},{"key":"bibr11-2164956119855629","doi-asserted-by":"crossref","unstructured":"Chuang E, Gil EN, Gao Q, Kligler B, McKee MD. Relationship between opioid analgesic prescription and unemployment in patients seeking acupuncture for chronic pain in urban primary care [published online ahead of print September 3, 2018].\n                      Pain Med\n                      . doi:10.1093\/pm\/pny169","DOI":"10.1093\/pm\/pny169"},{"key":"bibr12-2164956119855629","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuron.2011.02.001"},{"key":"bibr13-2164956119855629","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.0899"},{"key":"bibr14-2164956119855629","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.1464"},{"key":"bibr15-2164956119855629","volume-title":"Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research","author":"Institute of Medicine.","year":"2011"},{"key":"bibr16-2164956119855629","unstructured":"Interagency Pain Research Coordinating Committee.\n                      National Pain Strategy: A Comprehensive Population-health Level Strategy for Pain\n                      . https:\/\/iprcc.nih.gov\/sites\/default\/files\/HHSNational_Pain_Strategy_508C.pdf. Accessed December 23, 2018."},{"key":"bibr17-2164956119855629","doi-asserted-by":"publisher","DOI":"10.1007\/s13142-011-0094-3"},{"key":"bibr18-2164956119855629","doi-asserted-by":"publisher","DOI":"10.1016\/j.explore.2018.02.001"},{"key":"bibr19-2164956119855629","doi-asserted-by":"publisher","DOI":"10.7326\/M16-2367"},{"key":"bibr20-2164956119855629","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)30489-6"},{"key":"bibr21-2164956119855629","unstructured":"Centers for Medicare & Medicaid Services.\n                      Information on Essential Health Benefits (EHB)\n                      Benchmark Plans.\n                      https:\/\/www.cms.gov\/cciio\/resources\/data-resources\/ehb.html#ehb. Accessed November 15, 2018."},{"key":"bibr22-2164956119855629","unstructured":"Essential Health Benefits Requirements, 42 USC \u00a718022."},{"key":"bibr23-2164956119855629","first-page":"1","volume":"28","author":"Giovannelli J","year":"2014","journal-title":"Issue Brief (Commonw Fund)"},{"key":"bibr24-2164956119855629","first-page":"1","volume":"15","author":"Corlette S","year":"2013","journal-title":"Issue Brief (Commonw Fund)"},{"key":"bibr25-2164956119855629","unstructured":"Centers for Medicare & Medicaid Services, CCIIO.\n                      Illinois EHB Benchmark Plan\n                      . https:\/\/www.cms.gov\/CCIIO\/Resources\/Data-Resources\/Downloads\/Updated-Illinois-Benchmark-Summary.pdf. Accessed December 29, 2018."},{"key":"bibr26-2164956119855629","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association.\n                      Diagnostic and Statistical Manual of Mental Disorders (DSM-5\u00ae)\n                      . Washington, DC: American Psychiatric Publications; 2013.","DOI":"10.1176\/appi.books.9780890425596"},{"key":"bibr27-2164956119855629","unstructured":"Robert Wood Johnson Foundation.\n                      Essential Health Benefits: 50-state Variations on a Theme\n                      . Philadelphia, PA: Leonard Davis Institute of Health Economics, University of Pennsylvania; 2014."},{"key":"bibr28-2164956119855629","unstructured":"Centers for Medicare & Medicaid Services, CCIIO.\n                      Alabama EHB Benchmark Plan\n                      . https:\/\/www.cms.gov\/CCIIO\/Resources\/Data-Resources\/Downloads\/Updated-Alabama-Benchmark-Summary.pdf. Accessed December 29, 2018."},{"key":"bibr29-2164956119855629","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.h444"},{"key":"bibr30-2164956119855629","unstructured":"Centers for Medicare & Medicaid Services, CCIIO.\n                      Georgia EHB Benchmark Plan\n                      . https:\/\/www.cms.gov\/CCIIO\/Resources\/Data-Resources\/Downloads\/Updated-Georgia-Benchmark-Summary.pdf. Accessed December 29, 2018."},{"key":"bibr31-2164956119855629","unstructured":"Furman J.\n                      Six Economic Benefits of the Affordable Care Act\n                      . https:\/\/obamawhitehouse.archives.gov\/blog\/2014\/02\/06\/six-economic-benefits-affordable-care-act. Published 2014. Accessed May 25, 2019."},{"key":"bibr32-2164956119855629","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsb1706645"},{"key":"bibr33-2164956119855629","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-018-2125-4"},{"key":"bibr34-2164956119855629","unstructured":"Palanker D, Volk J, Giovannelli J. Eliminating Essential Health Benefits Will Shift Financial Risk Back to Consumers. The Commonwealth Fund. March 24, 2017. http:\/\/www.commonwealthfund.org\/publications\/blog\/2017\/mar\/eliminating-essential-health-benefits-financial-risk-consumers."},{"key":"bibr35-2164956119855629","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2017.304187"},{"key":"bibr36-2164956119855629","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2018.3044"},{"key":"bibr37-2164956119855629","doi-asserted-by":"publisher","DOI":"10.1177\/2164956118769557"},{"key":"bibr38-2164956119855629","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000002344"},{"key":"bibr39-2164956119855629","doi-asserted-by":"publisher","DOI":"10.1007\/s40258-016-0268-8"},{"issue":"1","key":"bibr40-2164956119855629","first-page":"32","volume":"1","author":"Situ D","year":"2012","journal-title":"Ann Palliat Med"}],"container-title":["Global Advances in Health and Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/2164956119855629","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/2164956119855629","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/2164956119855629","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T06:35:03Z","timestamp":1777444503000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/2164956119855629"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,1]]},"references-count":40,"alternative-id":["10.1177\/2164956119855629"],"URL":"https:\/\/doi.org\/10.1177\/2164956119855629","relation":{},"ISSN":["2164-957X","2164-9561"],"issn-type":[{"value":"2164-957X","type":"print"},{"value":"2164-9561","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,1]]},"article-number":"2164956119855629"}}