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.

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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