How do insurance denial appeals work?

Upload your denial letter and Lysco analyzes it, identifies the denial reason, cites applicable laws (ACA, ERISA, state regulations), and generates a customized appeal letter. You review and submit it yourself.

What is the success rate for insurance appeals?

It varies by plan type. For ACA marketplace plans, about 44% of appealed denials are overturned (KFF, 2023). For Medicare Advantage, it can be as high as 83% (HHS OIG). Many denials stem from billing or administrative errors that get fixed when challenged. Individual results vary.

Is Lysco a law firm or medical practice?

No. Lysco is an informational tool that helps you understand your rights and options. It is not a law firm, medical practice, or insurance company. For specific legal or medical situations, consult a licensed professional.

How much does Lysco cost?

Analysis is always free and your first appeal letter is free too. Upgrade to Pro ($29/mo) or Annual ($199/year) for unlimited appeal letters, deeper insurer-tailored analysis, and benefits finder. Cancel anytime.

Is my health data secure on Lysco?

Yes. Lysco uses AES-256 encryption at rest, TLS for data in transit, and row-level security so only you can access your data. We never sell your data and follow HIPAA-aligned security practices.

Rehabilitation Denial

TRICARE Denied Your Physical Therapy?

TRICARE (Military Health System) denies 12% of claims on average. But 55% of appeals succeed when patients fight back. Your physical therapy denial may have grounds for a successful appeal.

Analyze Your Denial Free Read the Appeal Guide

12%

Denial Rate

55%

Appeal Success

30-60 days

Typical Timeline

$2,000–$10,000

Typical Claim

Why TRICARE Denies Physical Therapy

Visit limit exceeded per plan year

Maintenance therapy — no longer improving

Prior authorization expired or not renewed

TRICARE's Common Denial Tactics

Denying non-network care when network providers unavailable

Prior authorization requirements for specialty referrals

Classifying care as not medically necessary per DoD criteria

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 TRICARE

TRICARE appeals go through the Defense Health Agency, not state regulators

Cite DoD medical necessity criteria specifically

Request a formal reconsideration before escalating to the DHA

Ready to Fight Your Physical Therapy Denial?

Upload your denial letter and get an AI-powered analysis in minutes. We'll identify the weaknesses in TRICARE's reasoning and build your appeal strategy.

Analyze My Denial Free

Analysis is always free. No credit card required.

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.