Cigna Denied Your Rehabilitation / PT / OT?
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.This template provides issues to verify, not insurer-specific outcome or deadline predictions. Your denial notice, current plan document, claim status, and governing program control.
Deadlines and review routes depend on plan type, urgent or standard status, whether care has already occurred, jurisdiction, and review level. Use the dates and instructions in the denial notice and current plan documents.
Why they said no
Common reasons Rehabilitation / PT / OT claims are denied
Maximum therapy visits reached for the year
Not making sufficient progress toward goals
Treatment deemed maintenance rather than restorative
Cigna checks
Issues to check in the Cigna notice
Ask what review occurred in your case — which criteria were applied and whether a clinician individually reviewed your records
Step-therapy requirements — check whether the plan credited medications you already tried
An "experimental" classification — compare it with the FDA-approved indication and the plan’s own medical policy
What works
How to Strengthen Your Rehabilitation / PT / OT Appeal
Therapist documentation of measurable functional improvement
Updated treatment plan with specific, measurable goals
Physician letter explaining medical necessity of continued therapy
Rules to verify
Rights and coverage rules that may apply
The plan’s rehabilitation or habilitation benefit — visit limits, settings, and authorization requirements remain plan-specific
Jimmo settlement principles — for Medicare, improvement potential cannot be the sole test for otherwise-covered skilled care
ACA or state mandates — apply only to specified services and regulated plan types; verify the actual plan document
Playbook
Tips for Appealing to Cigna
Request the name and credentials of the reviewer and written confirmation that a clinician conducted an individualized review
Gather evidence of prior failed treatments to counter step therapy requirements
Obtain peer-reviewed studies supporting FDA-approved treatments
Ready to Review Your Rehabilitation / PT / OT Denial?
Upload your denial letter and get a clear analysis in minutes. We'll identify potential weaknesses in Cigna's reasoning and outline your appeal options.
Analyze My Denial FreeYour first read is free. No credit card required.
Related denial guides
More Cigna denials
Rehabilitation / PT / OT denials by other insurers
This information is for educational and informational purposes only. It does not constitute legal or medical advice. This page cites no statistics; it lists issues to verify against your own denial notice, plan documents, and the governing rules. Individual results vary. Consult a qualified professional before taking action on your specific situation.