Chronic Pain Programs

Aetna covers screening exams and outpatient multidisciplinary chronic pain programs (non-malignant pain) and inpatient multidisciplinary programs up to 21 days when criteria are met, but excludes cancer pain, admissions only for evaluations, inpatient care beyond 21 days without review, and care for members with contraindications (e.g., violent behavior, imminent suicidality, prior failed program, unrealistic expectations, medical instability, inability to follow instructions) or nonparticipation. Key requirements: pain ≥6 months, failure of conventional treatments, any indicated surgery/acute treatment completed, mental health evaluation and treatment of primary psychiatric conditions, significant functional impairment, PCP/attending referral, pain not purely psychogenic; inpatient admission also requires major functional disability, need for extensive psychological/behavioral therapy, temporary removal from a detrimental home situation, and extensive family disruption.