Molina Healthcare Denied Your Physical Therapy?
Molina Healthcare Inc. denies 21% of claims on average. But 42% of appeals succeed when patients fight back. Your physical therapy denial may have grounds for a successful appeal.
Why Molina Healthcare Denies Physical Therapy
Visit limit exceeded per plan year
Maintenance therapy — no longer improving
Prior authorization expired or not renewed
Molina Healthcare's Common Denial Tactics
Denying specialist referrals as not medically necessary
Applying Medicaid criteria to marketplace plans
Delays in prior authorization processing
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 Molina Healthcare
Molina serves many Medicaid/marketplace enrollees — cite state Medicaid rules if applicable
File a complaint with your state Medicaid agency for Medicaid-managed care plans
Request expedited review if treatment is urgent
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 Molina Healthcare's reasoning and build your appeal strategy.
Analyze My Denial FreeAnalysis 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.