My insurer wants to stop paying for ongoing physical therapy. Do they have to keep paying while I appeal?

Health insuranceAppealChecked Nov 6, 2026

From K.Actuary, founded by Sangmin Kwon, ASA · sources checked 2026-11-06 · Source: GovInfo · 45 CFR 147.136 Internal claims and appeals (group) · § 147.136(b)(2)(iii) View original ↗

In short

Plans under this rule must keep coverage going while an appeal is open.
Benefits for ongoing treatment generally can't be cut without notice.
It covers group plans. It also covers insurers that sell individual plans.

What this means

For a plan subject to paragraph (b)(2) of the federal rule, coverage goes on while an appeal is open. Benefits for an ongoing course of treatment generally can't be reduced or ended without advance notice and a chance for advance review [1]. A company that sells individual health plans has the same duty [2].

The claims rule says that cutting or ending a course of treatment the plan had approved is an adverse decision, other than a cut made by plan amendment or termination. The plan has to tell you early enough to appeal and get an answer [3]. If the plan did not approve a set time, the answer may differ. The sources do not cover that.

Your next step

If you have a notice that approved treatment will stop, check whether you have a group health plan or an insurer selling individual coverage. The continued-coverage rule applies to both [1] [2]. The sources give no deadline.

Check it yourself

Your plan's notice and plan papers say which rules apply. Whether other plan types are covered is "Don't know yet" from these sources.

Where this comes from (3)

[1] GovInfo · 45 CFR 147.136 Internal claims and appeals (group) · § 147.136(b)(2)(iii) · checked 2026-11-06
Requirement to provide continued coverage pending the outcome of an appeal. A plan and issuer subject to the requirements of this paragraph (b)(2) are required to provide continued coverage pending the outcome of an appeal. For this purpose, the plan and issuer must comply with the requirements of 29 CFR 2560.503-1(f)(2)(ii) , which generally provides that benefits for an ongoing course of treatment cannot be reduced…
[2] GovInfo · 45 CFR 147.136 Internal claims and appeals (individual market) · § 147.136(b)(3)(iii) · checked 2026-11-06
An issuer subject to the requirements of this paragraph (b)(3) is required to provide continued coverage pending the outcome of an appeal. For this purpose, the issuer must comply with the requirements of 29 CFR 2560.503-1(f)(2)(ii) as if the issuer were a group health plan
[3] GovInfo · 29 CFR 2560.503-1 Claims procedure · § 2560.503-1(f)(2)(ii)(A) · checked 2026-11-06
If a group health plan has approved an ongoing course of treatment to be provided over a period of time or number of treatments- ( A ) Any reduction or termination by the plan of such course of treatment … The plan administrator shall notify the claimant, in accordance with paragraph (g) of this section, of the adverse benefit determination at a time sufficiently in advance of the reduction or termination to allow th…

How we found this

We matched your question to 3 official sources, quoted the exact lines, and re-checked each quote against its source on 2026-11-06.

What we don’t know yet

Your own plan or notice may say something different. If your letter cites another rule, send it and we will look again.

Every answer is checked against the official rule it quotes.

Information only — not legal advice. Your plan, insurer or agency decides.

This answer quotes the official sources listed above, with the date we checked them. Your own policy, notice and state rules control. We are not your lawyer or your insurer. We don’t file, argue or negotiate claims for you — you send any letter or form yourself.

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