The pain management “industry” has seen an unprecedented explosion in number of physicians and cost to the WC system over the last 15 years. We all know about the opioid prescribing behavior of these practices, but what other cost drivers come with a referral to a pain doctor and how can they be managed? What other procedures are interventionist physicians prescribing that may also be ineffective may drive up medical costs and which can cause a myriad of complications? Spinal Cord Stimulators, Intrathecal Pumps, Ketamine Injections, Substitution Therapy (Buprenorphine), spine injections, Laser Surgery along with new drug classes are becoming more common. Are they effective? When and under what circumstances? How can a claims service provider obtain a clear diagnosis and determine what appropriate treatment is and what it is not? How can they determine whether a pain physician is providing the most appropriate treatment or is simply doing interventions because they can (and can make money doing it)? How can you fight back if the treatment does not appear reasonable and appropriate?