When the plan says no, give the patient somewhere to go
PT, OT and speech therapy clinics, where visit caps and 'plateau' denials end care mid-plan. Apellica reads the denial for free, in writing, and prepares and files the appeal if it can be won. Nothing upfront for the patient; nothing paid or received by your office.
The denials you see
- Visit limits reached
- No longer medically necessary (plateau, maintenance)
- Pediatric therapy denied as developmental or educational
- Prior authorization for continued visits
The sentence at the desk
“The plan stopped covering your visits. Scan this: a free read tells you whether the cut-off can be appealed, including the rule that maintenance therapy can still be covered.”
That is the whole workflow. The card carries a QR code with your referral code, the patient scans it while the denial is in their hand, and every start is attributed to your office.
What happens next
- 1The patient uploads the denial letter (photos are read on their device; only the text is sent). A reviewer answers in writing, usually the same business day: appealable or not, which rule, what deadline.
- 2If it can be won, Apellica prepares the internal appeal with the criteria demand, the record mapped to each criterion, and primary-source citations, then the external-review request if the plan holds.
- 3Your office is asked once for what only it can supply: the plan of care with measurable goals and progress notes. The plan's criteria come with the request so the letter is written in one pass.
- 4The patient pays nothing upfront. If the appeal recovers coverage or money, the fee is 10% of the recovery; if not, nothing. Apellica is not a law firm and says so when a matter needs one.
What we will ask your office for
- The plan of care with measurable goals and progress notes
- The denial letter the patient received (the patient uploads it; you need do nothing)
- A letter of medical necessity written to the plan's criteria, once, when the appeal is being prepared; we send the criteria with the request
- Nothing else: no contract, no fee, no data feed
The numbers your patients should know
- Physical therapy appeal guide →
- Speech therapy decisions in California independent review →
- Physical therapy decisions →
Fewer than 1% of denied claims are appealed (KFF, 2024 HealthCare.gov filings). In California, independent reviewers sided with the patient in 52.5% of 42,710 decisions, and 72% in 2025 (DMHC). All research →
Your referral link
Codes use letters, digits and dashes; the suggested prefix for physical and occupational therapy is pt-. Paste the link into the denial message you already send patients, or put the QR card at the desk.
https://apellica.com/start?ref=pt-yourname&utm_source=partner&utm_medium=referral&utm_campaign=pt-yourname
Questions physical and occupational therapy ask
Medicare patients?
The Jimmo settlement means Medicare cannot deny skilled therapy because the patient is not improving; maintenance therapy that needs a skilled clinician is covered. The appeal cites it.
Is there any fee or revenue share?
No. Apellica does not pay or accept referral fees. Anti-kickback and state fee-splitting rules make that a risk for both sides; it is a link, nothing more.