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6 Insurance Facts You MUST Know About Music Therapy

Posted Apr 01 2013 2:44pm

health-insurance1-300x262I get a lot of confused calls about insurance coverage for music therapy each and every week.  I am dedicating this week’s blog post to laying out the facts and hopefully dispelling some of the myths. Here are my top 6 music therapy reimbursement facts that you must know!

1. Music Therapy CAN be a billable service under your health insurance.
Most plans do not have a specific section addressing benefits for music therapy. Finding out if music therapy can be covered is a complicated question because most of the customer service reps have still never heard of us! Work with your music therapist to find out if your health insurance covers music therapy. I’ve had a few calls from families saying that they would call their insurance to find out, and I never heard from them again. You can ALSO use HSA/FSA accounts to pay!

2. Every plan is different. If your neighbor down the street has the same insurance company and told you that music therapy wasn’t covered for them, it doesn’t mean that the same holds true for you. Not only are your plans likely written differently (different exclusions, different deductibles, co-pays, etc), your children probably have different diagnoses and have different goal areas to be addressed. Again, call your music therapist and talk with them about exploring your options for coverage. It might take a little while to get an answer from the insurance company, and it might take sending a claim in to find out, but your music therapist will help you to determine if your plan provides coverage for music therapy services.

3. Music Therapy bills insurance just like every other medical profession.  Our services are subject to deductibles and co-pays, visit limits, and exclusions like every other billable service. Depending on what area we are working on with our client and what codes are being billed, visits for those codes will be utilized. Again, it is very important to talk to your music therapist about these details. Some plans have small deductibles and no copay, some have only 30 visits a year for rehabilitative therapy services, and some have very large deductibles that will likely not be met in a year. Just like the plans themselves, each person’s situation is different and requires clarity.

4. Music Therapy reimbursement is not just for kids. Here at Key Changes, we do see a lot of kids, but did you know that we can bill insurance for adult services just like we do for children? The codes that are billable for music therapy services are not age specific. If the need for treatment is there, we can address it, and it is a billable service, we can bill for it!

5. Music Therapy is not currently covered under core Medicaid in any state in the US. I wish that it was. I’d be a Medicaid provider in a heartbeat, no matter how difficult everyone tells me it is. I’ve had to field calls from several families telling me that they had heard, or that someone had told them, that music therapy was covered by Medicaid. It is not. There are therapists with additional credentials (like SLP, LPC, OTL, etc) that may utilize music therapy techniques (and I hope that each of them are also MT-BC as well) in their work, but they are not billing Medicaid for music therapy.

6. Billing insurance for music therapy is no additional work for you. Other than possibly being anxious at the beginning as to whether or not it pays, rest assured that your music therapist will be open and communicate with you in regards to the billing process. As our field moves forward and grows, music therapists are becoming more and more knowledgeable about the billing process and can share that knowledge with you. Hopefully the day will come when we can have our doors as wide open as any doctor’s office and not have to have difficult discussion about insurance coverage. It will just be assumed to be covered.

Those are my facts, do you have any that I may have left off of the list? Let me know in the comments!

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