PT sessions getting denied denied despite still having benefit available. Appeal?

Hi, question about filing an appeal with my insurance due to being denied for more physical therapy sessions. We have blue cross blue shield and they use evi core as their third party for physical therapy authorizations. My son had a knee injury that required surgery. He started PT afterwards and has used 28 sessions. My insurance allows up to 72 visits per year. He is now getting denied for more sessions due to “musculoskeletal considerations” and “he is able to do more now” when I called to ask for more information the lady from evicore told me she had no other information beyond what was stated in the letter and she didn’t know what the musculoskeletal considerations were. Wildly unhelpful. His physical therapist has already done a peer to peer which they approved 3 more sessions for that but are now denying anymore. He is still unable to jump, run, or even skip. He plays sports and hasn’t been cleared to play. I’m going to submit an appeal (do they get approved?) and is there something else I can do to get more sessions approved? And if anyone has tips on best information to include in an appeal would appreciate that.

submitted by /u/Current-Doubt9267
[comments]

See also  Policy Cancelled