Durable medical equipment denied: how to appeal
The insurer denied equipment like CPAP, wheelchair, or insulin pump. Sleep study, mobility evaluation, or pump assessment.
Why this denial happens
- Medical necessity criteria not met
- Compliance criteria for CPAP not documented
- Prior trial of less expensive equipment not documented
What overturns it
- Sleep study, mobility evaluation, or pump assessment
- Compliance data (CPAP adherence reports)
- Prescriber letter
Evidence checklist
- ✓Diagnostic study
- ✓Compliance data
- ✓Prescriber letter
CPAP coverage often requires 70% usage 4+ hours per night across 30 consecutive days in the first 90 days.
Draft an appeal for a "DME" denial
Free analysis identifies the cited policy and missing evidence. Then a finished letter.
FAQ
What does "Durable medical equipment denied" mean on a denial letter?+
The insurer denied equipment like CPAP, wheelchair, or insulin pump.
How long do I have to appeal?+
180 days from the date of denial for ERISA group plans and ACA marketplace plans. 60 days for Medicare Advantage. Check the denial letter for your specific deadline.
What is the success rate for this kind of appeal?+
Outcomes vary, but medical-necessity and step-therapy appeals overturn at meaningful rates when the appeal cites the insurer's own policy and the chart documents the required criteria.
Other denial reasons
Not legal or medical advice. This page is a self-help resource. You make your own decisions. Strip personal identifiers (name, date of birth, address, member ID) from any document before uploading or sharing. The information here summarizes commonly-published payer policies and federal rules; confirm against your specific plan document and the current denial letter before acting.