Appeal type: Experimental/Investigational
Decision: Upheld Decision of Health Plan

Physician 1The patient is a 52-year-old female with a history of chronic back pain and kidney disease. The patient has attempted pain management with medication, over-the-counter supplements, and physical therapy. It has been noted that use of a TENS unit was not effective, but the patient did experience relief with interferential stimulation therapy. A request has been made for a home interferential stimulation therapy unit. The Health Plan has denied the request on the basis that interferential stimulation therapy is considered experimental.Interferential stimulation therapy has not shown to be of proven efficacy for chronic pain control in the case-controlled, peer-reviewed literature. However, the patient has limited options available for treatment and the Health Plan has agreed to provide interferential stimulation therapy through a physical therapy program. This alternative is equivalent or superior to providing a home unit as it allows the patient to have access to clinical expertise of the therapist applying the unit. Therefore, I have determined that the requested equipment is not likely to be more beneficial for treatment of the patients medical condition than any available standard therapy. The Health Plans denial should be upheld.Physician 2The patient is a 52-year-old female with radicular pain due to spinal stenosis and disc disease. The patients condition has been refractory to non-operative treatments other than interferential stimulation unit trials in physical therapy. Epidural steroid injections are not an option due to the patients history of steroid toxicity. No evidence of a spine surgical evaluation has been provided. The patient has requested authorization for a home interferential stimulation therapy unit. The Health Plan has denied the request on the basis that the requested equipment is considered experimental.The Health Plans denial should be upheld. An interferential stimulation unit for treatment of low back pain and radiculopathy due to disc disease and spinal stenosis has not been proven to be effective in placebo-controlled, randomized, clinical outcome trials. The alternative offered by the Health Plan is medically reasonable and appropriate.  Therefore, I have determined that the requested equipment is not likely to be more beneficial for treatment of the patients medical condition than any available standard therapy. The Health Plans denial should be upheld.Physician 3The patient is a 52-year-old female with a history of chronic back pain secondary to L4-L5 radiculitis, lumbar degenerative disc disease, spinal neural foraminal stenosis, and facet arthropathy. The patient also has a history of kidney disease and is unable to tolerate NSAIDs. In addition, the patient has experienced steroid-induced myopathy and is not a candidate for epidural steroid injection. The patient has undergone physical therapy, which included the use of a TENS unit without significant pain relief. The patient was also treated with an interferential stimulation unit during physical therapy sessions, which did provide improvement. The patient has requested authorization for a home interferential stimulation unit, which has been denied by the Health Plan based on the fact that there are no conclusive studies to support interferential stimulation therapy.The patients chronic back pain has been very difficult to treat because of her additional medical problems, which preclude the use of medications known to be of some benefit. Although the patient has found the interferential stimulation unit used during physical therapy sessions to be of benefit, the results of placebo-controlled trials have reported negative findings of interferential stimulation therapy. Additionally, the interferential stimulation unit used to treat the patient is a significantly different machine than the commercially available units suggested by the patients physiatrist, such that a home unit will not deliver the same results as the professional unit based on the technical superiority of the professional machine. Therefore, I have determined that the requested equipment is not likely to be more beneficial for treatment of the patients medical condition than any available standard therapy. The Health Plans denial should be upheld.