Humana Denied Your Physical Therapy?
Humana Inc. denies 14.2% of claims on average. But 56% of appeals succeed when patients fight back. Your physical therapy denial may have grounds for a successful appeal.
Why Humana Denies Physical Therapy
Visit limit exceeded per plan year
Maintenance therapy — no longer improving
Prior authorization expired or not renewed
Humana's Common Denial Tactics
Incorrect CPT/ICD coding as basis for denial
Claiming services duplicate prior treatments
Denying rehabilitation services as "not improving"
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 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
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.