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News | Oct. 25, 2022

Have Low Back Pain? You May Qualify for TRICARE Demonstration

By TRICARE Communications

There are many reasons to go to the doctor, but a very common reason is pain. Chronic pain—pain lasting three or more months—affects thousands of service members and their families every day. One such type of pain is low back pain.
 
The Military Health System is raising awareness about pain management. Did you know TRICARE has a Low Back Pain and Physical Therapy Demonstration? The demonstration is available in 10 states:
  • Arizona
  • California
  • Colorado
  • Florida
  • Georgia
  • Kentucky
  • North Carolina
  • Ohio
  • Tennessee
  • Virginia
 
“All of us experience pain in our lifetime,” said Erica Ferron, program manager for the Low Back Pain and Physical Therapy Demonstration. “How we experience, react to, and manage pain depends on the causes and symptoms behind a unique individual’s pain. Low back pain is one of the most common types of pain. It can affect our ability to function fully at work, at home, and in life in general. It’s a quality of life issue.”
 
Understanding low back pain
According to the Centers for Disease Control and Prevention, low back pain is very common. In fact, it causes more disability around the world than any other condition. Low back pain can result from injuries, conditions, or diseases. Some causes include arthritis, muscle strain, and disk injuries, to name a few. Your doctor may prescribe rest, physical therapy, medication, or other treatments to aid your recovery. Healing from lower back pain doesn’t happen overnight. Be sure to give it time, and check in with your doctor if necessary.
 
The majority of low back pain lasts less than four weeks from onset of symptoms and heals with self-care. Your doctor may recommend physical therapy for low back pain that doesn’t resolve with time or medication.
 
Understanding the demonstration
TRICARE developed the Low Back Pain and Physical Therapy Demonstration to address the ongoing issue of low back pain among service members’ family members and retirees and their family members. The demonstration:
  • Runs through Dec. 31, 2023.
  • Waives cost-shares for up to three covered physical therapy sessions for eligible beneficiaries. After the third covered physical therapy session, you’ll pay regular cost-shares and copayments for future covered sessions. Waived cost-shares don’t apply toward your annual deductible.
  • Doesn’t waive your point-of-service fees if you’re a TRICARE Prime enrollee.
 
To participate, you must:
  • Have a primary diagnosis of low back pain.
  • Have a referral from a TRICARE-authorized provider for physical therapy services to treat your low back pain.
  • Receive physical therapy services from TRICARE-authorized network provider after Jan. 1, 2021. If you have TRICARE For Life, however, you may receive physical therapy services from either a TRICARE-authorized network or non-network provider.
 
“We know that most beneficiaries will need more than three physical therapy visits to treat their pain,” Ferron said. “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 to all states and territories based on the demonstration’s results.
 
For additional info on eligibility for the Low Back Pain and Physical Therapy Demonstration, refer to the TRICARE website. To review your costs based on your health plan, check out the Compare Costs Tool.
 
Would you like the latest TRICARE news sent to you by email? Visit the TRICARE Subscriptions page today, and create your personalized profile to get benefit updates, news, and more.
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