Humana 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 Humana Denies Physical Therapy
Visit limit exceeded per plan year
Maintenance therapy — no longer improving
Prior authorization expired or not renewed
Humana patterns
Humana's Common Denial Patterns
Incorrect CPT/ICD coding as basis for denial
Claiming services duplicate prior treatments
Denying rehabilitation services as "not improving"
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 Humana
Verify CPT and ICD-10 codes match the services rendered
Get your provider to document functional improvement goals
For Medicare Advantage, cite CMS guidelines on coverage determination
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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.