Cigna Denied Your Physical Therapy?
Published data shows denial and appeal outcomes vary by plan, product year, denial reason, and documentation. Use this page to spot the issues to request and the evidence to gather before you decide what to submit.Sources include KFF ACA Marketplace Transparency Data, HHS OIG reports, and state insurance department filings. Aggregate rates are context, not predictions for an individual case.
Based on published government and industry research. Individual results vary based on denial type, insurer, and documentation.
Why they said no
Why Cigna Denies Physical Therapy
Visit limit exceeded per plan year
Maintenance therapy — no longer improving
Prior authorization expired or not renewed
Cigna patterns
Cigna's Common Denial Patterns
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
What works
How to Strengthen 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
Your rights
Laws That Protect You
ACA §2719 — Appeal rights
Jimmo v. Sebelius (Medicare) — Maintenance therapy coverage
State mandated minimums for PT visits
Playbook
Tips for Appealing to Cigna
Reference the documented pattern of high-speed automated denial review and request proof of individualized physician review
Gather evidence of prior failed treatments to counter step therapy requirements
Obtain peer-reviewed studies supporting FDA-approved treatments
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Related denial guides
More Cigna denials
Physical Therapy denials by other insurers
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.