Introduction
Have you or your child been denied insurance coverage for essential physical therapy sessions? If so, you’re not alone. Insurance denials can be incredibly frustrating, especially when you’re dealing with essential recovery care like physical therapy after an ACL surgery.
It’s important to know that you have the right to challenge these decisions and get the coverage you deserve!
Understanding the Process
Insurance companies often deny claims, even for necessary care like physical therapy following an ACL tear. We had a parent whose daughter tore her ACL, who has been working with us and she shared how, “Insurance will deny physical therapy for something that is critical to these athletes and their rehab.” After multiple denials, our patient’s mom found a way to fight back through the appeals process and ultimately won coverage.
Here’s how she did it and how you can fight back and get the coverage you deserve:
Step 1: : Filing Your First Appeal
The first denial is common. Start by filing a Level 1 Appeal. Your healthcare provider can help with this, making sure all necessary documentation is included. This is your initial chance to challenge the denial, but be prepared—insurance companies often reject these appeals too.
Step 2: The Final Adverse Determination Letter
If your Level 1 Appeal is denied, you’ll receive a Final Adverse Determination Letter. This is key to moving forward with your External Appeal to the state where your insurance is based. Our patient’s mom shared her tip: submitting your external appeal online speeds up the process.
Note: Don’t let the paperwork confuse or deter you.
Step 3: Build Your Case
To strengthen your appeal, gather the following:
- Letters of Medical Necessity from your doctor and physical therapist, explaining why the therapy is crucial.
- A personal letter detailing your experience and why the treatment is essential for recovery.
Attach these documents when you file your external appeal, and ensure all forms are filled out accurately.
Step 4: Persistence Pays Off
Though this process can be time-consuming, many people successfully overturn insurance denials with perseverance. Stay organized and patient—you’re essentially building a case for why your therapy is medically necessary.
Our patient’s mom had to file multiple external appeals but ultimately succeeded. Her advice is preparing all the necessary documents beforehand, filling in forms by hand, and scanning them to ensure a smooth process when uploading online.
Final Thoughts
Insurance companies often count on patients giving up when faced with denials, but with the right approach, you can fight back. If you’re struggling, don’t hesitate to ask your physical therapy provider for help—they can often assist with paperwork and appeals.
At Myokinetix, we’ve helped patients navigate this complicated process, and we’re committed to supporting you in getting the care you need.
If you’re facing insurance denials for essential rehab, don’t give up! Stay persistent, follow the steps above, and lean on experts to ensure your recovery isn’t delayed by red tape.
Book a call with us today and learn how we can help you get the care you deserve!