I’ve been referred to a pain clinic that offers a special program called functional restoration. But when I checked with my insurance company, they said they don’t cover those services. Is there some way I can get them to change their minds?

Usually a letter of justification supporting the medical necessity of such a program is needed by the patient’s physician. Your doctor will summarize all of his or her findings. Reasons for this recommendation are outlined.

Studies support the benefit of FR when looking for ways to manage chronic low back pain that help the patient get back to work. A team approach with nursing, physical therapy, occupational therapy, and nutritional and behavioral counseling is used.

At first glance, FR may seem more costly than usual or standard care. But studies show that over time, usual care ends up costing twice as much as FR. The reason for this is that FR reduces disability and reduces the risk of reinjury. With standard care, many patients end up coming back to see the health care provider over and over.

If your insurance carrier does not change their policy for you, there may still be a way to obtain the services you need. Reimbursement can be billed for on an individual basis.

There are codes that each health care provider relies upon for payment. For example, the physical therapist can bill for therapeutic exercise, biofeedback, or neuromuscular re-education. The psychologist can bill for individual psychotherapy or behavior modification. Other codes are available for other health care specialists.

You’ll have to check and find out what services your policy covers and pay out-of-pocket for those that are not covered.