Regence BlueShield denied my chiropractic, physical therapy, or massage therapy claim, saying I needed preauthorization — is that actually a valid reason?

In October 2025, Washington state Insurance Commissioner Patty Kuderer fined Regence BlueShield $100,000 after finding the insurer had incorrectly denied 954 real claims between June 11, 2020, and May 25, 2022, by requiring preauthorization for a group of services — chiropractic, physical therapy, occupational therapy, acupuncture and Eastern medicine, massage therapy, and speech and hearing therapies — where the plans in question did not actually require it. These were not ambiguous judgment calls; they were denials issued under a rule that, on Regence's own plan terms, did not apply to the claims it was used against.

Once the state forced Regence to reprocess the 954 claims, the amount the insurer itself paid out rose from $11,139 to $85,982, and what patients had been left paying out of pocket rose too — from $6,114 to $31,724 — because the correct cost-sharing and deductible terms were applied for the first time. That gap, multiplied across fewer than a thousand claims, is the clearest evidence of how much an incorrectly applied preauthorization rule can cost an individual patient who never challenged the denial.

If a health insurer denies your claim for "no preauthorization," the first and only question that matters is whether your specific plan actually required it for that specific service — not whether the insurer's claims system flagged it as missing. Ask the insurer, in writing, to point to the exact plan provision requiring preauthorization for your service. If it cannot, or the provision does not clearly cover what you received, that is the same gap Washington's regulator found at scale — and your state Department of Insurance takes complaints for free, tracks insurers' complaint ratios closely, and is exactly the kind of pressure that got 954 other people's claims reprocessed.