What to do when letter of medical necessity is denied?

Hi,

To make it simple I was going to PT for a complicated case that has had slow improvement but improvement. Every 5 visits I need a progress note. Though my score improved it wasn't enough so I got partial denial with 2 visits to end therapy. My physiatrist and pain management said PT was necessary. Physiatrist wrote a letter of medical necessity to appeal the partial denial explaining my condition may worsen and requested 3 months of PT. They responded with 2 more visits to wrap up therapy. Is there any repercussions or ways to escalate ie department of insurance?

I was told I can wait 90 days to open a new case after the expiration of the original authorization but that will cost me thousands in PT.

I was in so much pain I literally couldn't sleep one night more than 40 minutes from exhaustion. I needed to go to PT to help release the muscle causing me severe pain and pay cash. I still have ongoing muscle spasms that require a PT to release.

Any suggestions?

submitted by /u/Appointment_Witty
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