Navigating the insurance maze can be a confusing and intimidating process, especially when verifying your therapy benefits. To make matters worse, most insurance company customer service representatives are not aware that music therapy is often a covered service, so they do not answer music therapy benefit questions correctly. Never fear, The George Center is here!
Here are the answers to the most frequently asked questions regarding music therapy insurance reimbursement.
1. Are music therapists considered in network or out of network providers?
Music therapists are considered out of network providers with all insurance companies… for now.
Unfortunately, there are not enough MT’s billing insurance companies to make it worth their while to contract with individual music therapy providers and practices. We have yet to find an insurance company that even has an application available to MT’s to apply as in network providers. As more music therapists begin billing 3rd parties it should become evident to insurance providers that contracting with MT’s will be cost saving for the insurance company as well as the member. Meanwhile, we have had a few clients request and receive approval for temporary in network status for our providers. This request can be directed toward a plan’s case manager and is subject to medical necessity.
2. Are music therapy services subject to deductibles? Co-pays?
Music therapy services are subject to deductibles, co-pays, visit limits, and exclusions just like any other allied health service. It is your responsibility to be aware of your out of network deductible as this must be met before any out of network service (including music therapy) will be covered.
3. Is there a specific CPT (Current Procedural Terminology) code that music therapists use?
The CPT codes that are appropriate for music therapists to utilize are not discipline specific and are also used by related healthcare professionals (i.e., physical, occupational, speech, behavioral, and recreational therapy). Once an evaluation has been completed, and treatment goals have been outlined, our team of fabulous clinicians will choose the CPT code that appropriately fits the treatment implemented. It is extremely important to communicate with other therapists involved in the client’s treatment so we can adhere to proper billing procedures and avoid a duplication of services.
4. Does Aetna/Cigna/United Health Care/Humana/BCBS/etc. cover music therapy services?
Just because your friend has the same insurance company as you and has music therapy coverage does not mean that the same holds true for you! Every plan is different. Many plans are self insured and funded by your employer and the insurance company just underwrites the plan. In the case of a self-insured plan it is not the insurance company's decision whether music therapy is a covered service or not, it is the employer's. Additionally, insurance providers offer many different tiered plans, changing the number of visits allowed, deductibles, co-pays, and covered services. For example, your plan might have a music therapy exclusion where another member does not.
5. Does Medicaid cover music therapy services?
No, but I hope that will change very soon. Many state task forces are working with their local Medicaid offices to advocate for the inclusion of music therapy as a covered service. The American Music Therapy Association is also advocating at the national level for inclusion. Right now core Medicaid does not cover music therapy services anywhere, but many state waiver programs do.
6. Why won’t BCBS of Georgia cover music therapy services?
Until this year BCBS of Georgia reported that music therapists could not be recognized as covered providers because they were not licensed by the state. However, the Georgia music therapy licensure bill was passed in 2012 and was effective January 1, 2014, but MT is still not a covered service under all BCBS of Georgia plans. We are educating and advocating and hope to resolve this mater soon. Keep in mind that many out of state BCBS plans DO cover music therapy.
7. Does insurance only cover music therapy for children?
Of course not! Evidence-based practice and research supports the use of music therapy with a plethora of ages and diagnoses, including any adult populations.
8. Do we need a prescription for music therapy services?
Yes! In order to bill 3rd party insurance for music therapy we must have a current prescription for services on file. No worries, we can fax your primary care physician directly and request this information!
9. What happens if a music therapy claim is denied?
We appeal. However, please remember that our relationship is with you, not your insurance company. We do our best to fight for our client’s rights to their medical and behavioral benefits and we pride ourselves on a high insurance reimbursement success rate, but we do not win every fight. A verification of benefits does not guarantee coverage and an insurance company can deny a claim at any time pending medical review, visit limits, proof of medical necessity, or for no reason at all! Many times an appeal on a denied claim can take anywhere from 3 months to a year! You are financially responsible for your account at all times, regardless of whether insurance has paid claims or not. If a denial is received, we will bill the client for services while the appeal is being handled. If we receive payment from the insurance company for previously denied claims, we will reimburse the client immediately for any out of pocket expense incurred.
10. Can I use my FSA/HSA/HRA account to pay for music therapy services?
Yes! Our practice is listed a medical provider/service and can process FSA/HSA/HRA debit and credit cards. We can also provide an invoice for reimbursement under your health benefits.