Request for Coverage Denied

hey all,

in october 2019, i injuried my back deadlifting (ego, poor form, spotters not calling me out). it got better for a while, then hit a stopping point. when i finally decided i needed to seek medical attention, the pandemic began. in april 2021, i was finally able to visit my doctor. she wrote a PT script for chronic back pain. i’ve been going since early may and just filled out the insurance request for more visits. today, i got the letter from my insurance company that my request had been denied because PT is “not medically necessary” for my condition.

i am unable to do at home tasks as simple as the laundry without pain, as i cannot bend over for more than a few seconds without hurting. i have been in pain for almost 20 months and just want to get better. if i cannot be treated, i will have to change my future career plans as the two paths i am considering (incoming college freshman) require a healthy back and i am currently unable to carry anything more than ~25 lbs without causing pain. it’s days like today i wish i could just go back in time and slap myself for being egotistical and continuing to push dangerously.

how should i go about appealing this? i’m devastated because i was finally starting to get some relief after spending so long in pain and terrified my condition would only worsen with age. what approach will best increase my chances of being granted more sessions? do i call the insurance company beforehand? do i ask my physical therapist at our next session?

submitted by /u/rrjbam
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hey all, in october 2019, i injuried my back deadlifting (ego, poor form, spotters not calling me out). it got better for a while, then hit a stopping point. when i finally decided i needed to seek medical attention, the pandemic began. in april 2021, i was finally able to visit my doctor. she wrote a PT script for chronic back pain. i’ve been going since early may and just filled out the insurance request for more visits. today, i got the letter from my insurance company that my request had been denied because PT is “not medically necessary” for my condition. i am unable to do at home tasks as simple as the laundry without pain, as i cannot bend over for more than a few seconds without hurting. i have been in pain for almost 20 months and just want to get better. if i cannot be treated, i will have to change my future career plans as the two paths i am considering (incoming college freshman) require a healthy back and i am currently unable to carry anything more than ~25 lbs without causing pain. it’s days like today i wish i could just go back in time and slap myself for being egotistical and continuing to push dangerously. how should i go about appealing this? i’m devastated because i was finally starting to get some relief after spending so long in pain and terrified my condition would only worsen with age. what approach will best increase my chances of being granted more sessions? do i call the insurance company beforehand? do i ask my physical therapist at our next session?
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