Health, Wellness, and BeautyInsurance & Reimbursement4HighTherapist$ implied
Insurance denied a patient's 7th visit even though the patient still can't climb stairs, forcing the therapist to find alternative diagnosis codes to continue care.
Insurance authorization systems do not adequately consider functional progress; they rely on diagnosis codes and visit limits that force clinicians to game the system.
52
0
Opp. Score
52
Severity
4High
Willingness to Pay
implied
Added
Apr 28, 2026
Workarounds Described
- using a different diagnosis code to get more visits
- getting referral for something else that is still objectively measurable
Implied Software Gaps
- Software that automatically tracks functional outcomes and insurance visit limits to prevent denials
- Tool that suggests alternative diagnosis codes based on objective measures to ensure coverage continuity
App Concept
AuthPro Therapy
A software that automates insurance authorization for therapy by documenting functional outcomes and objective measures, automatically generating justification letters, and tracking visit limits to avoid denials.
Key Features
- Automated functional outcome tracking with patient-reported and clinician-measured data
- Real-time insurance policy lookup and visit limit alerts
- One-click generation of insurance justification letters with objective evidence
- Integration with EHR to capture diagnosis codes and progress notes
Target Users: Physical therapists, occupational therapists, and speech therapists in outpatient clinics and private practices.
Revenue Model: $49/mo per user SaaS subscription with a free trial for first 30 days.
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