UnitedHealthcare denied my CPAP after I already had it. Can they do that?

Yes, and it is common. Coverage of PAP devices is usually conditional on documented adherence during an initial trial, so a retroactive denial can arrive months in. Get the compliance report from your supplier first — if the data actually meets the threshold, the denial is a records problem and often reverses. If it does not, ask for a new trial period with the barrier documented.

What makes a wheelchair or scooter denial reverse?

A face-to-face evaluation note that rules out lesser equipment step by step, in your actual home environment. Vague statements that you have difficulty walking do not clear the bar. A therapist evaluation describing distances, transfers, and doorway or threshold limits is the strongest single document.

Do I appeal UnitedHealthcare or the equipment supplier?

Appeal the plan, but start by calling the supplier. A meaningful share of DME denials come from a wrong billing code, a missing prescription detail, or an out-of-network supplier, and the supplier can fix those with a corrected claim faster than an appeal would resolve them.

Guides · UnitedHealthcare · appeals · Updated August 2026

How to appeal a UnitedHealthcare durable medical equipment denial

Durable medical equipment denials from UnitedHealthcare rarely turn on whether you need the device. They turn on paperwork: a face-to-face visit note that does not say the right things, missing compliance data, or a supplier that billed the wrong code. That is frustrating, but it also means these are fixable more often than clinical denials.

Why UnitedHealthcare denies this

UHC applies detailed coverage policies to DME, and its Medicare Advantage plans layer Medicare's own DME rules on top. Two patterns dominate. First, CPAP and other PAP devices: coverage typically depends on a qualifying sleep study plus documented adherence during an initial trial period — commonly at least four hours per night on 70 percent of nights across a 30-day stretch within the first 90 days. Miss that window and the device is denied retroactively, sometimes after months of use. Second, mobility equipment: denials usually cite a face-to-face evaluation note that fails to document why a lesser device — cane, walker, manual chair — will not meet your needs inside the home. The reviewer is checking documentation boxes, not re-examining you.

What wins the appeal

For PAP devices, get the machine's compliance download from your supplier — it is objective data and it is the whole case. If adherence fell short, get a note explaining why: mask fit problems, a documented side effect, an illness or hospitalization during the trial, and ask for a new trial period rather than arguing about the old one. For mobility equipment, get a face-to-face evaluation note that walks through the lesser devices in order and says specifically why each one fails for you in your home — thresholds, distances, fatigue, transfers. A physical or occupational therapist evaluation carries real weight here. Also confirm the supplier is in-network and billed the correct HCPCS code, since a coding mismatch produces a denial that looks clinical but is not. Commercial appeals generally allow 180 days; Medicare Advantage plans typically allow 60 days, so verify which clock you are on.

Your deadline

Depends on your plan type: 180 days for most employer and marketplace plans, 120 for Original Medicare, ~90 for Medicaid, and only 65 for Medicare Advantage. Set it before you do anything else.

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Common questions

UnitedHealthcare denied my CPAP after I already had it. Can they do that?: Yes, and it is common. Coverage of PAP devices is usually conditional on documented adherence during an initial trial, so a retroactive denial can arrive months in. Get the compliance report from your supplier first — if the data actually meets the threshold, the denial is a records problem and often reverses. If it does not, ask for a new trial period with the barrier documented.
What makes a wheelchair or scooter denial reverse?: A face-to-face evaluation note that rules out lesser equipment step by step, in your actual home environment. Vague statements that you have difficulty walking do not clear the bar. A therapist evaluation describing distances, transfers, and doorway or threshold limits is the strongest single document.
Do I appeal UnitedHealthcare or the equipment supplier?: Appeal the plan, but start by calling the supplier. A meaningful share of DME denials come from a wrong billing code, a missing prescription detail, or an out-of-network supplier, and the supplier can fix those with a corrected claim faster than an appeal would resolve them.