Molina Healthcare 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 Molina Healthcare Denies Physical Therapy
Visit limit exceeded per plan year
Maintenance therapy — no longer improving
Prior authorization expired or not renewed
Molina Healthcare patterns
Molina Healthcare's Common Denial Patterns
Denying specialist referrals as not medically necessary
Applying Medicaid criteria to marketplace plans
Delays in prior authorization processing
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 Molina Healthcare
Molina serves many Medicaid/marketplace enrollees — cite state Medicaid rules if applicable
File a complaint with your state Medicaid agency for Medicaid-managed care plans
Request expedited review if treatment is urgent
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Related denial guides
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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.