How To Get A TENS Unit Covered By Insurance

Chronic pain is a debilitating issue that makes completing even the simplest tasks infinitely harder. Of course, there are numerous traditional pain treatments available, such as nonprescription and prescription medications, trigger-point injections, and acupuncture, but these aren’t always effective.

Fortunately, many chronic pain sufferers have found relief using a less-traditional pain treatment called transcutaneous electrical nerve stimulation (TENS). However, the main problem in using TENS isn't its effectiveness but rather the hurdles involved in getting insurance to cover it. The following information will help you understand how to get a TENS unit covered by insurance.

What is TENS Therapy?

TENS involves delivering a weak electrical current via electrodes to the skin’s surface near the origin of pain. The electrical current passing through the electrodes stimulates the nerves in the treatment area. This electrical stimulation causes the nerves to go haywire. Instead of sending normal pain signals to the brain, they send undecipherable signals. The brain cannot interpret the signals, thus reducing pain depending on its severity.

Although TENS is often mis-conceptualized as a painful process, most likely due to the use of electricity, the application is painless. Despite its sophisticated name, transcutaneous electrical nerve stimulation is a simple application that can be implemented at home using a TENS unit – a battery-powered mobile device.

How Effective is TENS Therapy?

The effectiveness of TENS is a heavily-debated matter and one with a broad spectrum of differing opinions. There have been countless medical trials based on the efficacy of TENS in treating pain, but, for the most part, the results have remained inconclusive. TENS was once a popular method for treating chronic lower back pain; however, it has recently been deemed ineffective for this use by the American Academy of Neurology (AAN).

Researchers are unsure how TENS provides pain relief. It's theorized that TENS reduces pain by causing a release of endorphins. Colloquially referred to as "feel-good" chemicals, endorphins are chemicals produced naturally by the body that alleviate stress and pain. Some believe TENS can block the pain pathways responsible for providing pain relief.

Despite the scrutiny of TENS, countless patients and physicians swear by its efficacy in relieving chronic pain, post-surgical pain, and other similar ailments.

What Health Issues is TENS Used in Treating?

In a sense, the lack of conclusive evidence as to the benefits of TENS matters none. The only thing that matters is the patients, and where all other pain treatments have failed, they are finding relief from their symptoms through TENS.

The symptoms that TENS is commonly used in treating include:

• Chronic intractable pain
• Post-surgical pain
• Active or post-trauma injury pain
• Pain caused by diabetic neuropathy
• Dementia

Will Insurance Cover a TENS Unit?

For many patients who rely on TENS therapy to treat their pain, purchasing a TENS unit out-of-pocket is not viable. Unfortunately, getting health insurance to cover the cost of the unit is sometimes difficult and always requires following strict guidelines. But do not be deterred because the following will help answer the question as to how to get a TENS unit covered by insurance.

Every health insurance provider has policies, coverage plans, and premiums, and the covered medical supplies vary significantly. For example, certain insurers refuse to cover TENS units, regardless of the patient's circumstances. On the other hand, many insurance providers will cover the cost of the TENS units so long as the patient fulfills the criteria listed in their policy.

Generally, the criteria for getting a TENS unit covered by insurance are the same. Here are the basics:

• TENS therapy must be deemed medically necessary and effective in treating the primary health issue – in this case, pain. 
• For TENS therapy to be deemed medically necessary, patients must undergo a 30-day trial of transcutaneous electrical nerve stimulation treatment, preceded by a reassessment of the symptoms.

The post-trial reassessment of the patient’s pain-related symptoms must indicate:

• The frequency with which the TENS unit was used during therapy and the average duration of use during each therapy session.
• The effectiveness of TENS in relieving the patient's pain-related symptoms.

In addition, the following criteria need to be met:

• The pain has been unresponsive to conservative medical therapy for a minimum of 3 months; AND
• The trial occurs under the direct supervision of a medical professional.

Continued use of the TENS unit will be deemed medically necessary for the treatment of pain if the following criteria are met:

• The efficacy of TENS therapy was established during the initial trial.
• The TENS unit was used throughout the initial TENS therapy trial.

TENS therapy, including the TENS unit, will not be covered if:

• TENS therapy is not deemed medically necessary.
• TENS therapy is only deemed necessary for post-operative pain, not for acute pain.
• TENS therapy is being used to treat non-pain-related conditions, such as dementia and headaches.

Coverage by Major Insurance Provider

As stated prior, coverage eligibility will vary based on the carrier. Below, we higlight major insurance providers and their policy on TENS unit coverage.

Are TENS Units Available for Purchase?

Patients do have the option to purchase their own TENS unit, and doing so does not require a prescription from a doctor. While the devices themselves are affordable, you will have to continue to purchase additional electrodes, which can drive the cost up if used frequently. And if the TENS unit malfunctions, the patient will be forced to purchase a new unit. In contrast, if insurance covers the cost of the unit, the policy should provide a new model.

Let Insurance Cover It

Chronic pain is a condition that affects millions of people across the globe. And while there is no cure-all for chronic pain, there are treatments that help reduce its symptoms, such as over-the-counter medications, surgery, and TENS therapy. 

Transcutaneous electrical nerve stimulation works by scrambling the signals from the nerves to the brain, which temporarily eliminates pain in the treated area. There is some skepticism by researchers regarding the effectiveness of TENS therapy. Still, many patients find that it’s the only treatment that offers a respite from chronic pain.

The convenience of TENS therapy makes it particularly appealing because it can be applied at home by using a mobile TENS unit. The costs can quickly add up if using electrodes every day, so it’s best to find an insurance provider that will cover the cost of the unit and the supplies. It may be an arduous process, but knowing how to get a TENS unit covered by insurance will go a long way in easing your pain.

TENS Therapy Related Resources

About the Author

Brandon Landgraf is the Digital Marketing Manager for Carex Health Brands. He finds passion and fulfillment in creating content that enhances, improves, and enlivens others' quality of life. All of his written work is formulated to not only offer essential advice and tips but back it with proven studies and experts. His mission is to connect with readers and provide steps to make their lives better.

You can connect with him on LinkedIn here.

About Carex Health Brands

Carex is your one-stop shop for home medical equipment and for products that assist caregivers with providing the best possible support and care for their loved ones. Carex Health Brands has been the branded leader in in-home, self-care medical products for over 35 years. Our goal is to improve the lives of our customers by bring them quality products that bring dignity back to their lives. With our three nationally distributed brands, Carex Health Brands serves national, regional and independent food, drug and mass retailers along with wholesalers, distributors and medical dealers.