"When we decided to try private therapy until the early intervention would start in the fall, I looked at both my and my husband's employee handbook for guidelines. Both carriers required a doctor's prescription, listed qualifications of the physical therapist, and supervision of the therapy by a physician. So following guidelines for both primary and secondary insurance, we started physical therapy. It wasn't until months of claims were submitted, that the insurance company sent denial letters. That's when I found out that only 1/3 of families appeal denied claims and insurance companies depend on people either not appealing or giving up, even though most of the time it's turned around on first appeal. But families must be persistent. Keep copies of everything and send it certified return receipt. We had the doctor who prescribed the therapy send a note saying it was medically necessary. Doctor's notes are golden and often all that is needed is a prescription; but if that isn't sufficient a note of "medically necessary" will usually resolve this. The insurance companies kept asking for additional information such as treatment and diagnosis codes, tax id, therapist license, etc. This went on for a year and a half, then they finally relented. Ironically, the following year my husband's insurer actually put an addendum in the employee handbook that they no long cover these types of therapies for children. Fortunately by that time our child was getting services through early intervention, and later related services under IDEA at school."
-Story from a parent advocate
