Physical therapy denied by insurance — how to appeal

About Physical therapy

PT denials typically arise when the plan's visit cap is reached or when the insurer determines further PT isn't medically necessary. The strongest appeals document measurable functional progress (range of motion, strength, pain reduction) and the clinical reasoning for additional sessions.

Common reasons Physical therapy gets denied

• Number of covered visits exceeded
• Not medically necessary determination
• Plan visit cap reached
• Functional progress documentation insufficient

Evidence that helps overturn a Physical therapy denial

• PT progress notes showing measurable functional improvement
• Provider letter explaining clinical necessity for continued PT
• Documentation of how cessation would impact recovery

Recommended approach

For most Physical therapy denials, our triage will recommend the Strong Appeal ($249) tier. We prepare a professionally-structured appeal that addresses the specific denial reason, cites the relevant clinical evidence, and meets your insurer’s appeal-rights deadlines. Treatment cost exposure: typically $75–$200 per session.

What to do next

1. Find your denial letter (or EOB) and check the appeal deadline.
2. Upload it to InsureDefense for a free triage — no payment required to see the assessment.
3. If you choose to proceed, you’ll receive a draft within 24 hours (12 hours for urgent cases).
4. Submit the appeal to your insurer using the fax / portal / mailing address we provide.
5. Track the insurer’s response using our 14/30/45-day follow-up reminders.

Upload your Physical therapy denial See pricing