So You've Been Denied Coverage: Now What?

I've often said that music therapy's biggest weakness can also serve as it's biggest asset: our low visibility.

In some ways, it's good to be unknown. Whenever I tell people what I do, their interest is instantly piqued and they want to know more. I doubt they'd be as excited to listen to me if I said I was a physical therapist. News outlets are often eager to write stories about music therapy, which I can't help but think is mainly tied to the unique nature of what we do.

However, there are some serious liabilities associated with the low visibility of music therapy. People often just don't understand what we do and assume we're simply volunteer musicians doing something nice or a bunch of new-age, alternative medicine mumbo-jumbo.

And sometimes, those people work for insurance companies.

Insurance denials are not all that uncommon for any therapy field. Sadly, insurance coverage for autism in particularly leaves a lot to be desired, with some companies just flat out stating they don't cover autism at all. Thankfully, the very dedicated autism community is fighting to change that.

But even so, denials are bound to happen sometimes, especially if your field is less established than comparable healthcare fields.

Learn to play the game

It's an unfortunate reality, but many times getting coverage for services is all about playing the game. The insurance companies have strategies and methods they use to minimize the cost to them, and many times these methods can feel downright unfair to you, their paying customer. So while it's far from ideal, you gotta be prepared to play the game.

So your insurance company denied coverage for music therapy: Now what?

It can be tempting when denied coverage to just throw up your arms, give up, and mutter some choice words about those dadgum insurance types. But consider just how likely you are to get the denial overturned if you do nothing. Yep, there's about a 0% chance of that happening.

So you really should have two mottos when faced with a denial:

1) "The squeaky wheel gets the oil"

No one's going to know you're upset unless you tell them. And a large corporation like a health insurance company certainly isn't going to know unless you really make it known.

Now, I'm not saying you need to turn into a screaming, cursing, angry tyrant on the phone with insurance reps. That's not likely to get you far. But do make sure you're heard. Call. Call again. Follow up. Stay on them!

Make sure you keep concise notes when speaking with your insurance company. Write down the names of the people you talked to, when you talked to them, what they said, and the reference number for the call. Many of the calls are recorded, so if you're denied coverage for a service a representative previously told you you were approved for, tell them to go back and listen to the call! It's not likely the insurance company will advocate on your behalf, so you need to be the one who holds them accountable.

2) "Knowledge is power"

Know your plan! Be informed! Being knowledgable about your insurance coverage can prevent a lot of these issues before they happen. Maybe your plan has an exclusion that your service provider (music therapist, speech-language pathologist, etc.) doesn't know about. If they try to bill under that exclusion, the insurance company will deny it. Save yourself the trouble in the first place and make sure YOU know your plan, and you communicate it to your providers.

Additionally, denials can often be overturned by providing evidence that the service in question is effective and based in research. Here at The George Center, we keep meticulous notes on sessions so we can provide them as evidence of effectiveness in the event of a denial. We'll also work with you to provide research from independent third parties that support the use of music therapy with various populations to the insurance company to help them understand what we do, why it works, and why is should be covered.

Why do we do this? Mainly because we want to help you get covered! That's why we successfully bill insurance for 85% of our clients.

But it's also an opportunity to advocate. Every time we fight this battle, we're informing another insurance representative of music therapy and its effectiveness. We do this so that next time an insurance claim from a music therapist comes across their desk, even if it's on the other side of the country, they'll know that what we do works.

Questions about your insurance, music therapy, or both? Sign up for a free consultation with our team and get your questions answered!

 

Andrew Littlefield MM, MT-BC

The George Center , 12060 Etris Road, Roswell, GA, 30075