Cigna Denied Your Physical Therapy?
Cigna Healthcare (The Cigna Group) denies 18.5% of claims on average. But 52% of appeals succeed when patients fight back. Your physical therapy denial may have grounds for a successful appeal.
Why Cigna Denies Physical Therapy
Visit limit exceeded per plan year
Maintenance therapy — no longer improving
Prior authorization expired or not renewed
Cigna's Common Denial Tactics
Mass auto-denials (300,000 claims in 2 months at 1.2 seconds each)
Requiring step therapy for medications your doctor already tried
Denying claims as "experimental" despite FDA approval
How to Win Your Physical Therapy Appeal
Objective measurement of functional progress (ROM, strength, balance scores)
Treatment plan with specific, measurable goals
Documentation that cessation would cause regression
For Medicare: cite Jimmo v. Sebelius settlement requiring maintenance coverage
Laws That Protect You
ACA §2719 — Appeal rights
Jimmo v. Sebelius (Medicare) — Maintenance therapy coverage
State mandated minimums for PT visits
Tips for Appealing to Cigna
Reference the ProPublica investigation into automated denials
Gather evidence of prior failed treatments to counter step therapy requirements
Obtain peer-reviewed studies supporting FDA-approved treatments
Ready to Fight Your Physical Therapy Denial?
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This information is for educational and informational purposes only. It does not constitute legal or medical advice. Statistics cited are from publicly available sources including KFF, HHS OIG, and state insurance department data. Individual results may vary. Consult a qualified professional before taking action on your specific situation.