AXA Health Insurance Complaint About Denied Physical Therapy

Approximately two months ago, I injured my ankle while playing football. Initially, I did not consider the injury serious, but as my symptoms gradually worsened, I sought medical attention at the Orthopedics Department of Özel Avcılar Daviva Hospital. Following an examination, the orthopedic specialist determined that 15 sessions of physical therapy were medically necessary and recommended this treatment.

Under my supplementary health insurance policy No. 8103620 with AXA Sigorta A.Ş., I submitted a pre-authorization request for the recommended treatment. However, as stated in the pre-authorization denial form dated October 10, 2026, my request, No. 31623, was rejected on the grounds that I had exhausted my outpatient treatment coverage.

Following my pre-authorization application, my previous radiology results, hospital visits, and medical history were reviewed in detail. Despite the fact that there was no record of any previous treatment or diagnosis related to the same condition, my request was denied on the grounds stated above.

This raises a serious contradiction from my perspective. If your system already clearly indicated that my outpatient treatment coverage had been exhausted, why was such an extensive review of my previous medical records necessary, and what was the purpose of this investigation? If the reason for denial was already established, I request an explanation of why this review was conducted and how the resulting delays and inconvenience to the insured party can be justified.

I also request a clear explanation of why the physical therapy deemed medically necessary by the orthopedic specialist was not evaluated under any of the other benefits included in my policy. In particular, I expect a clear written explanation of whether the treatment could be covered under the inpatient treatment or physical therapy and rehabilitation benefits, provided the relevant policy conditions are met.

I request that this medically necessary treatment be covered under the appropriate benefit category available under my policy. I expressly reject the current pre-authorization denial decision and formally appeal it. I expect AXA Sigorta to review my case and provide a detailed written response explaining the applicable coverage provisions and the reasons for its decision.