Music therapy is won and Kaiser Permanente is to pay
Over 2 years ago, when we needed emergency care for our then 4 year old living with severe OCD ( and autism of course) that was debilitating her daily life,
did I realize and really understand that there was no type of emergency service other than the emergency room.
As parents we needed strategies and help. Not a fix for the moment but to be able to help her to over come or at least find strategies and ways to cope and get us through the tough days.
This is when the whole fight with our insurance company started.... Kaiser Permanente
I started the process fighting Kaiser Permanente for what I knew my daughter needed at such a debilitating time of her life.
Her well being was at stake and we experienced her regressing in a way that we had never experienced before. Her daily routine became very challenging and the sleepless nights not good for anyone.
Spending a very long number of months going through her OCD, we were at a loss as parents. Music therapy I would discover can be an immediate way to treat , calm and help a child. While the child engages themselves within the notes of beautiful music. This would soon be our daughters experience.
Seeking help from our medical insurance Kaiser Permanente we sought to see a psychiatrist. An appointment was made for both my husband and I to see someone through the kaiser phone service.
We were never asked to bring our daughter and even after the very short and non productive visit with the psychiatric practicing student was it ever recommended to bring our daughter in. Not even to see her pediatrician or otherwise.
Let me make this clear... Kaiser Permanente never asked to see our daughter that was going through all this.
Yes as parents we should of asked more and made other appointments but let me just tell you that during this time it was difficult enough to deal with the day to day things. And as we sought the help from the psychiatric department we had put faith in them, to much I will now add.
The only out come that came 30 days after our visit with the psychiatric department was that Kaiser would authorize ABA for her. Not having other options at the time we put that whole process in motion. Having been through ABA before and its processes I knew there had to be something more uplifting and immediate.
This is when I looked further into the idea of music therapy.
I had heard about it and found it intriguing and was very curious.
So I did a lot more research and decided that Hannah would benefit from this.
As I researched I found great evidence that music therapy helped autistic children , OCD and anxiety as well.
(plus of course many more wonderful results) and that the benefits were immediate.
After much time had passed already we needed this for Hannah.
I had already filed a grievance with Kaiser Permanente and was well into the process of building a case.
After I received the denial from Kaiser Permanente saying that music therapy was
1.not covered by her evidence of coverage,
2.not medically necessary
3.and finally not evidence based
did I then turn my time to the Department of Health Management here in California and started a case there.
This was a very time consuming endeavor I will tell you but I built a very strong case. And in fact I had lawyers turning to me from the DMHM asking me for more of my research.
After much back and forthing and many long hours on my end did I receive the right to a IMR
(independent medical review).
The department of health management here in California was at an in- pass with Kaiser Permanente so they sent it off to be reviewed by someone not affiliated with any of this.
After a few months the IMR came back in our favor, we had won.
Over 2 years ago, when we needed emergency care for our then 4 year old living with severe OCD ( and autism of course) that was debilitating her daily life,
did I realize and really understand that there was no type of emergency service other than the emergency room.
As parents we needed strategies and help. Not a fix for the moment but to be able to help her to over come or at least find strategies and ways to cope and get us through the tough days.
This is when the whole fight with our insurance company started.... Kaiser Permanente
I started the process fighting Kaiser Permanente for what I knew my daughter needed at such a debilitating time of her life.
Her well being was at stake and we experienced her regressing in a way that we had never experienced before. Her daily routine became very challenging and the sleepless nights not good for anyone.
Spending a very long number of months going through her OCD, we were at a loss as parents. Music therapy I would discover can be an immediate way to treat , calm and help a child. While the child engages themselves within the notes of beautiful music. This would soon be our daughters experience.
Seeking help from our medical insurance Kaiser Permanente we sought to see a psychiatrist. An appointment was made for both my husband and I to see someone through the kaiser phone service.
We were never asked to bring our daughter and even after the very short and non productive visit with the psychiatric practicing student was it ever recommended to bring our daughter in. Not even to see her pediatrician or otherwise.
Let me make this clear... Kaiser Permanente never asked to see our daughter that was going through all this.
Yes as parents we should of asked more and made other appointments but let me just tell you that during this time it was difficult enough to deal with the day to day things. And as we sought the help from the psychiatric department we had put faith in them, to much I will now add.
The only out come that came 30 days after our visit with the psychiatric department was that Kaiser would authorize ABA for her. Not having other options at the time we put that whole process in motion. Having been through ABA before and its processes I knew there had to be something more uplifting and immediate.
This is when I looked further into the idea of music therapy.
I had heard about it and found it intriguing and was very curious.
So I did a lot more research and decided that Hannah would benefit from this.
As I researched I found great evidence that music therapy helped autistic children , OCD and anxiety as well.
(plus of course many more wonderful results) and that the benefits were immediate.
After much time had passed already we needed this for Hannah.
I had already filed a grievance with Kaiser Permanente and was well into the process of building a case.
After I received the denial from Kaiser Permanente saying that music therapy was
1.not covered by her evidence of coverage,
2.not medically necessary
3.and finally not evidence based
did I then turn my time to the Department of Health Management here in California and started a case there.
This was a very time consuming endeavor I will tell you but I built a very strong case. And in fact I had lawyers turning to me from the DMHM asking me for more of my research.
After much back and forthing and many long hours on my end did I receive the right to a IMR
(independent medical review).
The department of health management here in California was at an in- pass with Kaiser Permanente so they sent it off to be reviewed by someone not affiliated with any of this.
After a few months the IMR came back in our favor, we had won.
The doctor from the IMR sided with me after reading all that I had submitted and after his own research determined that music therapy was medically necessary for our Hannah and Kaiser had 5 days to respond and get this set up.
Imagine our excitement. I also later learn that we are the trail blazers and the only people that have won music therapy to be paid for by Kaiser Permanente in California. Huge deal
Imagine our excitement. I also later learn that we are the trail blazers and the only people that have won music therapy to be paid for by Kaiser Permanente in California. Huge deal
OCD, Autism and Music Therapy
some of my research coming soon....
some of my research coming soon....