UnitedHealthcare Denied Your Physical Therapy?
According to federal data, UnitedHealthcare (UHG) denies approximately 22.2% of claims. When patients appeal, about 44% are overturned. Your physical therapy denial may have grounds for a successful appeal.Sources: KFF ACA Marketplace Transparency Data, HHS OIG Reports, state insurance department filings. Rates are aggregate averages — individual results vary by plan type, denial reason, and documentation.
Based on published government and industry research. Individual results vary based on denial type, insurer, and documentation.
Why UnitedHealthcare Denies Physical Therapy
Visit limit exceeded per plan year
Maintenance therapy — no longer improving
Prior authorization expired or not renewed
UnitedHealthcare's Common Denial Tactics
AI-powered automated denials that may lack individualized physician review
Prior authorization requirements for standard procedures
Narrow network restrictions denying out-of-network emergency care
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 UnitedHealthcare
Cite the No Surprises Act for emergency or out-of-network denials
Document that the denial lacks evidence of individualized physician review
Request the qualifications of the reviewer who denied your claim
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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.