UnitedHealthcare denied surgery pre-auth - what are my options?

My orthopedic surgeon submitted a prior auth for knee surgery (torn meniscus, confirmed on MRI) and UnitedHealthcare denied it saying the procedure isn't "medically necessary" yet and I need to try six weeks of physical therapy first.

I've already done PT twice, including 8 weeks last year after the first partial tear. The surgeon says another injury has made it worse and PT won't fix it at this point. He submitted all of that documentation and they still said no.

I filed an appeal two weeks ago and haven't heard back. I know they have 30 days on standard appeals but my surgeon says waiting is making things worse. Any advice on pushing for an expedited review or going external? I'm in Texas if that matters for state laws.