Tricare Offers Special, Limited Program to Treat Low Back Pain

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Older man receiving physical therapy
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Jim Absher is a benefits columnist for Military.com

Tricare is looking for active-duty service members, retirees and dependents with lower back pain who want to receive free physical therapy treatments.

A pilot program, running from Jan. 1, 2021 through Dec. 31, 2023 designed to treat one of the most common causes of disability in the U.S., affecting at least 25% of adults, is available exclusively to Tricare members in 10 states nationwide.

The pilot program, designed to last until Dec. 31, 2023, offers three free physical therapy sessions for beneficiaries suffering from lower back pain.

Some causes of lower back pain include arthritis, muscle strain and injuries. Your doctor may prescribe rest, physical therapy, medication or other treatments to help you get better. No matter what treatment method is used, healing from lower back pain usually takes time.

Who Is Eligible?

Tricare beneficiaries with a primary diagnosis of low back pain and a physical therapy referral from a Tricare-authorized provider are eligible to participate in the program according to Tricare. For most, the physical therapy provider must be in-network; however, those using Tricare for Life can use either a network or non-network provider.

The program is available to Tricare participants living in:

  • Arizona
  • California
  • Colorado
  • Florida
  • Georgia
  • Kentucky
  • North Carolina
  • Ohio
  • Tennessee
  • Virginia

The pilot program waives cost shares for up to three physical therapy sessions to treat back pain. After the third covered physical therapy session, regular cost-shares and copayments apply.

Why Is Tricare Running a Back Pain Treatment Pilot Program?

An analysis of Tricare claims conducted by the Defense Health Service showed that retirees were nearly 50% less likely than others to receive physical therapy treatments for lower back pain. One factor that may contribute to this is the fact that retirees have a higher copay or out-of-pocket cost than other groups of Tricare beneficiaries.

While the majority of low back pain lasts less than four weeks and heals with self-care, there are times when it doesn't go away so quickly. In these cases, your doctor may recommend physical therapy or medication to ease the pain.

Many conventional medical treatments for lower back pain, such as drugs or surgery, either have a risk of drug addiction or dangerous side effects or are cost-prohibitive. Physical therapy has shown promise in eliminating the pain more rapidly than conventional methods, and is cheaper in the long run while having fewer side effects, according to Tricare.

"We know that most beneficiaries will need more than three physical therapy visits to treat their pain," said Erica Ferron, program manager for the new program, the Low Back Pain and Physical Therapy Demonstration, said in a press release. "Whether you're in a demonstration state or not, you have access to Tricare's physical therapy benefit. We hope that by removing the fees for the initial visits, some people will try, and benefit from, physical therapy -- especially those who might not have otherwise tried it."

Even if you don't have access to the demonstration, Ferron encourages anyone with low back pain that lasts longer than a few weeks to make an appointment with your provider to help decide which treatment may be best for you. At the end of the demonstration, Tricare will decide whether to expand the benefits based on participation in the pilot program.

For more details, see Tricare's Low Back Pain and Physical Therapy Demonstration website.

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