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Durable Medical Equipment denials: what the review data shows
Independent reviewers have decided 2,679 published cases where an insurer denied durable medical equipment — and they overturned the insurer 44.6% of the time. If your denial is in this category, the odds say: appeal.
Published decisions
2,679
2001–2026
Overturned
44.6%
1,196 denials reversed
By denial reason
The excuse on the letter changes the odds — and the counter-strategy.
| Denial reason | Decisions | Overturned |
|---|---|---|
| medical necessity | 1,976 | 44.6% |
| experimental / investigational | 703 | 44.7% |
Within this category
Subcategories with at least 15 published decisions.
| Subcategory | Decisions | Overturned |
|---|---|---|
| Other | 987 | 40.8% |
| Electric Wheelchair | 160 | 23.1% |
| Wheelchair | 141 | 27% |
| Orthotics | 133 | 69.2% |
| CPM Machine | 108 | 39.8% |
| Electric Scooter | 100 | 9% |
| Glucose Monitor | 100 | 76% |
| Prosthesis | 94 | 51.1% |
| Special Bed | 88 | 45.5% |
| Braces | 81 | 35.8% |
| Insulin Pump | 76 | 68.4% |
| C-Pap Machine | 66 | 56.1% |
| Cont Glucose Monitor | 62 | 88.7% |
| Compression Garments | 57 | 42.1% |
| Wearable Cardio Defib | 53 | 64.2% |
| Elect Bone Stim | 53 | 32.1% |
| Oxygen | 44 | 18.2% |
| Shoe Inserts | 38 | 68.4% |
| Pneumatic Vest | 33 | 48.5% |
| Special Chair | 27 | 63% |
How to use this in your appeal
These are outcomes from California’s external review program — an independent physician panel that binds the insurer. Every state has an equivalent process, and internal appeals succeed even more often. Cite the category outcome when you appeal: reviewers routinely find that denials like yours didn’t hold up.
SOURCE: CALIFORNIA DMHC INDEPENDENT MEDICAL REVIEW OUTCOMES (CHHS OPEN DATA) · DERIVED AGGREGATE STATISTICS ONLY · METHODOLOGY
Not legal or medical advice. Coverage Rights is a self-help tool that helps you prepare your own appeal. For advice about your specific situation, talk to a licensed attorney or your doctor.