Kentuckiana Pain Specialists tells Medicare patients to time pain care around open enrollment

Kentuckiana Pain Specialists is advising Louisville-area Medicare patients to keep ongoing pain pump care on schedule during open enrollment and delay new spinal cord stimulation trials until after plans change on Jan. 1. The guidance matters because a new Medicare Advantage plan may require fresh prior authorization for procedures that have not already started.

Why it matters: - Medicare coverage decisions made during open enrollment can determine whether a pain procedure gets approved next year. - For patients with chronic back, neck or nerve pain, a coverage change can affect treatment timing, out-of-pocket costs and whether a planned procedure is delayed. - Medicare Advantage insurers fully or partially denied 7.7% of prior authorization requests in 2024, according to KFF. - Of the denials KFF counted, only 11.5% were appealed, and 80.7% of those appeals overturned the original decision.

What happened: - Kentuckiana Pain Specialists is urging Medicare patients in Louisville, Anchorage, Prospect, Lyndon, Jeffersontown and Crestwood to continue care already underway while comparing plans before the Dec. 7 open enrollment deadline. - Medicare open enrollment runs from Oct. 15 through Dec. 7, 2026, and changes take effect Jan. 1, 2027, according to the Centers for Medicare and Medicaid Services. - The practice says intrathecal pain pump therapy refills can continue under current coverage. - The practice says patients switching plans should delay spinal cord stimulation trials that have not yet started until after Jan. 1.

The details: - A federal rule finalized in 2023 gives a new Medicare Advantage member in an active course of treatment a transition period of at least 90 days before a new prior authorization requirement can apply to that ongoing treatment. - Procedures that have not begun do not get that protection, so a new plan reviews them from the start. - The practice says treatment that is already working should continue on schedule, including pump refills, follow-up visits and spinal injections that are part of an established plan. - Delaying a scheduled pump refill or follow-up to wait for a coverage change can create more risk than it avoids. - A spinal cord stimulator trial is a short test period with temporary leads, and a successful trial is usually followed by implantation weeks later. - If a plan changes between the trial and the implant, the implant may face a new review by an insurer that never approved the trial. - Patients who keep the same plan do not need to wait. - Practice staff verify coverage and handle authorization before procedures are scheduled. - Patients considering a switch can ask the office which upcoming treatments need approval and which plans on their shortlist the practice accepts.

Between the lines: - The guidance is less about premiums and more about preserving continuity of care. - The strongest caution applies to procedures not yet started, where the next insurer can reset the review process. - The appeal statistics cited by the practice suggest that patients should challenge denials they think are wrong instead of assuming a first answer is final.

What's next: - Patients choosing a new Medicare plan will need to decide before Dec. 7 whether to keep current care moving or postpone new procedures until after Jan. 1. - The practice says it will continue verifying benefits and managing authorizations before scheduling procedures. - Ajith Nair, M.D., says patients and reporters can contact the practice about Medicare coverage and interventional pain care.

The bottom line: - If pain treatment is already underway, keep it moving. - If a spinal cord stimulation trial has not started and a plan change is likely, waiting until after open enrollment may reduce coverage surprises. - More information