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The article discusses the coverage of family and marital therapy by managed care organizations in the U.S. in 2006. While managed care organizations generally recognize family and marital therapy as a vital modality in the treatment of certain individuals, they need to enforce coverage rules when managing the health plans of other entities. Thus, they deny family and marital therapy as non-covered services for other patients in some cases.

The article discusses issues concerning the medical reviews required by managed care organizations (MCOs) and insurance companies and whether they can be done after rather than during treatment. If reviews are not read until after treatment, MCOs and insurance companies are not aware of the services until they receive the claim. If reviews are done retrospectively, the MCOs could audit the charts and the documentation, find discrepancies, and possibly rescind authorization.

The article discusses the concept of administrative denials in health insurance reimbursement. An administrative denial is the findings from a managed care organization or an insurance company in which due to certain provisions of a patient's health plan, a service is not covered under the health plan despite clinical merit. Insurance companies and managed care organizations can still issue administrative denials even if the service is medically necessary.

The article reports on the likelihood for behavioral health providers and provider organizations in the U.S. to receive denials from managed care organizations and insurance companies. Prevention is a better approach to denials. When denials do happen, the appeal process is a nice approach to reverse them and get reimbursed.