Once your device is delivered and you’re ready for therapy, the care you receive is shaped by a process most patients never see. Understanding it helps you know what to expect - and where you can push back. Linsey Porter, an occupational therapy assistant who has also worked in billing and coding, walked us through how it typically unfolds.

The Authorisation Cycle

It begins with a benefits check before treatment starts, where the clinic runs your insurance to confirm what it covers for therapy. This sets the boundaries for everything that follows.

At your first visit, the therapist conducts an evaluation - documenting your current functional level and setting goals. In some states and with some insurers, this evaluation has to be submitted for approval before treatment can continue.

That submission goes to the insurer as a prior authorisation. The insurer looks at the gap between where you are now and where you need to be to function independently at home, and authorises a set number of sessions - typically four to eight. Sessions are usually about an hour, two or three days a week, depending on your level of care and schedule.

On the last authorised visit, the physical therapist - not the assistant - reassesses you in what amounts to a recertification. It’s almost a re-evaluation: re-measuring joint spaces and muscle mass, testing gait and balance, and documenting progress. That recertification is submitted to the insurer to request more sessions.

The insurer then reviews your progress and makes a reauthorisation decision. They might approve another batch - say, six visits - if you’ve improved but haven’t yet reached your functional goals. The cycle repeats. If you feel ready, the therapist can complete a discharge on a final visit. If you still can’t perform daily activities safely - you can’t bend to tie your shoes, your hips hurt from walking on the limb - another recertification goes in, and the insurer may approve something limited, such as one visit a week for four weeks, before closing the case.

Two Kinds of Plans

Not all coverage works the same way. Some policies allocate a yearly dollar amount for therapy that you can use as needed until it runs out. Others authorise therapy in batches, requiring a recertification and reauthorisation for each round of visits. Either way, the documentation has to be completed at every stage - and even an “open” plan gets reviewed, with the insurer able to decide you’ve plateaued and close the case.

Where You Can Push Back

If you’re denied additional sessions and still can’t perform daily activities safely, that’s the moment to push - through your therapist, through your prosthetist, and directly with your insurer.

Continued therapy often comes down to the therapist’s judgment. “It’s been two weeks, there’s no improvement - morally, ethically, I can’t keep treating you,” Linsey says. But that isn’t the end of the road. If you still can’t manage a task like putting on your shoes, the next step is adaptive equipment or another workaround so you can function in daily life. The goal doesn’t change - only the path to get there.

This is the reference piece on the therapy side of Finding Care and Fighting for What You Deserve. For the device-denial side, see Part 3 - When Insurance Says No. For choosing a plan and self-advocacy, see Part 4 - Choosing a Plan and Advocating for Yourself. To start from the beginning, see Part 1 - Finding a Therapist Who Understands Limb Loss.

Linsey Porter is an occupational therapy assistant based in Northwest Indiana with nearly 12 years of experience across inpatient rehabilitation, skilled nursing, telehealth, and billing and coding.

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