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

Medicare Denied Your Rehabilitation / PT / OT?

Centers for Medicare & Medicaid Services (CMS) denies 18% of claims on average. But 75% of appeals succeed when patients fight back. Your rehabilitation / pt / ot denial may have grounds for a successful appeal.

Analyze Your Denial Free Read the Appeal Guide

18%

Denial Rate

75%

Appeal Success

60-90 days

Typical Timeline

$2,000–$20,000

Typical Claim

Why Medicare Denies Rehabilitation / PT / OT

Maximum therapy visits reached for the year

Not making sufficient progress toward goals

Treatment deemed maintenance rather than restorative

Medicare's Common Denial Tactics

Denying claims as not reasonable and necessary

Coverage determinations based on LCD/NCD criteria

Denying skilled nursing facility stays as custodial care

How to Win Your Rehabilitation / PT / OT Appeal

Therapist documentation of measurable functional improvement

Updated treatment plan with specific, measurable goals

Physician letter explaining medical necessity of continued therapy

Laws That Protect You

ACA — Rehabilitative and habilitative services as EHB

Jimmo v. Sebelius — improvement not required for Medicare coverage

Mental Health Parity and Addiction Equity Act

Tips for Appealing to Medicare

Medicare has a 5-level appeal process — most denials are overturned by level 2 or 3

Request an ALJ hearing if redetermination and reconsideration fail

Cite specific LCD/NCD criteria and explain how your case meets them

Ready to Fight Your Rehabilitation / PT / OT Denial?

Upload your denial letter and get an AI-powered analysis in minutes. We'll identify the weaknesses in Medicare'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.