Medical equipment and supplies: 56% of denials overturned

Year by year

By treatment

Treatments with at least 20 decisions, most decisions first. Rates on fewer than 20 decisions aren’t shown.

Recent decisions

The most recent decisions in the data, half overturned and half upheld. Each shows the reviewer’s published findings.

1. Overturned 2026 · Medical necessity · age 31–40 Hospital beds assoc supplies · Malfor/Deform/Abnor The physician reviewer found that a patient has requested authorization and coverage for ProBed Freedom Bed. A specialized hospital bed is medically necessary due to the patient’s limited mobility and elevated risk for pressure injury. The patient requires a…

   The physician reviewer found that a patient has requested authorization and coverage for ProBed Freedom Bed. A specialized hospital bed is medically necessary due to the patient’s limited mobility and elevated risk for pressure injury. The patient requires a bed that provides assisted repositioning and does not rely on upper‑extremity strength to operate, and the ProBed Freedom Bed offers features that meet these needs. Given these factors, the requested ProBed Freedom Bed is medically necessary for the treatment of this patient. Final Result: The reviewer determined that the requested equipment is medically necessary for the treatment of the patient's medical condition. Therefore, the Health Plan's denial should be overturned. Credentials/Qualifications: The reviewer is board-certified in physical medicine and rehabilitation and is actively practicing. The reviewer is an expert in the treatment of the patient's medical condition and knowledgeable about the proposed treatment through recent or current actual clinical experience treating those with the same or a similar medical condition.

   Case MN26-46951

2. Overturned 2026 · Medical necessity · age 11–20 Oxygen delivery sys supplies · Lungs and breathing The physician reviewer found that the patient’s parent has requested reimbursement and prospective authorization and coverage for Vest Airway Clearance high frequency chest wall oscillation system. According to the medical literature, airway clearance is a…

   The physician reviewer found that the patient’s parent has requested reimbursement and prospective authorization and coverage for Vest Airway Clearance high frequency chest wall oscillation system. According to the medical literature, airway clearance is a primary focus in the treatment of pediatric patients with neuromuscular weakness, and assisted coughing or airway‑clearance support is indicated when cough clearance is impaired. High frequency chest wall oscillation devices are used to aid airway clearance and reduce the risk of lower respiratory tract complications. Based on the records, this patient has several factors that increase the risk of impaired airway clearance and is unable to adequately perform pulmonary function testing due to underlying intellectual and neuromuscular disorders. High frequency chest wall oscillation has been well‑tolerated and effective for this patient, and medical literature supports its use in pediatric patients with neuromuscular disorders, including cerebral palsy. Overall, the Vest Airway Clearance high frequency chest wall oscillation system is safe, effective, and clinically appropriate for this patient, and removing the device would place the patient at significant risk for recurrent respiratory illness. For these reasons, the Vest Airway Clearance high frequency chest wall oscillation system was and is medically necessary for the treatment of this patient. Final Result: The reviewer determined that the device at issue was and is medically necessary for the treatment of the patient's medical condition. Therefore, the Health Plan's denial should be overturned. Credentials/Qualifications: The reviewer is board-certified in pediatrics with subspecialty certification in pediatric pulmonology and is actively practicing. The reviewer is an expert in the treatment of the patient's medical condition and knowledgeable about the proposed treatment through recent or current actual clinical experience treating those with the same or a similar medical condition.

   Case MN26-46941

3. Upheld 2026 · Medical necessity · age 21–30 Accs oxygen deliv devices · Brain and nerves The physician reviewer found that a patient has requested authorization and coverage for a Jaco Gen 2 robotic arm. In this case, the patient has Duchenne muscular dystrophy (DMD) with significant upper‑extremity functional limitations. The patient has…

   The physician reviewer found that a patient has requested authorization and coverage for a Jaco Gen 2 robotic arm. In this case, the patient has Duchenne muscular dystrophy (DMD) with significant upper‑extremity functional limitations. The patient has difficulty elevating the shoulders and moving the elbow joints to perform daily activities of living. The record indicates that the patient has trialed the robotic arm and was able to complete certain tasks. While the request is intended to improve functional ability, there is insufficient medical literature supporting the use of this device in patients with DMD, and available studies are limited and qualitative. Additionally, the clinical documentation does not clearly establish the patient’s current level of independence or the likelihood of meaningful improvement with the device. As such, the requested Jaco Gen 2 robotic arm is not reasonable and necessary to protect life, prevent significant illness or disability, alleviate severe pain, or restore functional capacity. Therefore, the requested Jaco Gen 2 robotic arm is not medically necessary for this patient. Final Result: The reviewer determined that the device is not medically necessary for the treatment of the patient's medical condition. Therefore, the Health Plan's denial should be upheld. Credentials/Qualifications: The reviewer is board-certified in physical medicine and rehabilitation and is actively practicing. The reviewer is an expert in the treatment of the patient's medical condition and knowledgeable about the proposed treatment through recent or current actual clinical experience treating those with the same or a similar medical condition.

   Case MN26-46906

4. Overturned 2026 · Medical necessity · age 0–10 Accs oxygen deliv devices · Mental health The physician reviewer found that Nature of Statutory Criteria/Case Summary: The patient’s parent has requested authorization and coverage for a Cubby Bed. Patients with risk factors, including patients with cognitive impairments or weakness, may require a…

   The physician reviewer found that Nature of Statutory Criteria/Case Summary: The patient’s parent has requested authorization and coverage for a Cubby Bed. Patients with risk factors, including patients with cognitive impairments or weakness, may require a bed with additional safety measures, such as specialized padding or an enclosed bed to prevent falls and entrapment. Cubby Beds (enclosed beds) are generally reserved for refractory cases of sleep and behavioral disturbances at night that do not respond to other approaches such as behavioral treatments and modifications to the patient’s bed and room. In this case, the patient presents with autism spectrum disorder requiring substantial support. Based on the records, the patient elopes at night, placing the patient at danger of death or severe injury. The patient has been using a crib, but is able to exit it and chews on it. Alternative treatments have been tried with limited efficacy and unsustainability. Overall, multiple strategies have been attempted and the patient has failed first-line measures for nighttime sleep safety. As such, this patient requires a higher level of intervention with a safety bed. Additionally, the requested Cubby Bed is medically necessary to achieve or maintain age-appropriate growth and development, attain, regain, or maintain functional capacity, or improve, support, and maintain the patient’s current health condition. For these reasons, the requested Cubby Bed is medically necessary for the treatment of this patient. Final Result: The reviewer determined that the requested equipment is medically necessary for the treatment of the patient's medical condition. Therefore, the Health Plan's denial should be overturned. Credentials/Qualifications: The reviewer is board-certified in neurology with special qualification in child neurology and is actively practicing. The reviewer is an expert in the treatment of the patient's medical condition and knowledgeable about the proposed treatment through recent or current actual clinical experience treating those with the same or a similar medical condition.

   Case MN26-46873

5. Overturned 2026 · Medical necessity · age 11–20 Monitoring equipment · Hormones and metabolism The physician reviewer found that Nature of Statutory Criteria/Case Summary: A patient has requested authorization and coverage for the FreeStyle Libre 3 Plus sensor. Blood glucose monitoring is essential for the management of diabetes mellitus and may also…

   The physician reviewer found that Nature of Statutory Criteria/Case Summary: A patient has requested authorization and coverage for the FreeStyle Libre 3 Plus sensor. Blood glucose monitoring is essential for the management of diabetes mellitus and may also be beneficial in pre-diabetes and for the evaluation of hypoglycemia. Options for blood glucose monitoring include self-monitoring with finger sticks and a glucometer, or a continuous glucose monitor (CGM). Brands of effective CGM devices include FreeStyle Libre 3. However, the patient has previously used others and found them inaccurate and painful. Accuracy in CGM monitoring is key, as it determines insulin delivery via the insulin pump. Therefore, the requested FreeStyle Libre 3 Plus sensor is medically necessary for the treatment of this patient. Final Result: The reviewer determined that the requested equipment is medically necessary for the treatment of the patient's medical condition. Therefore, the Health Plan's denial should be overturned. Credentials/Qualifications: The reviewer is board-certified in endocrinology, diabetes, and metabolism and is actively practicing. The reviewer is an expert in the treatment of the patient's medical condition and knowledgeable about the proposed treatment through recent or current actual clinical experience treating those with the same or a similar medical condition.

   Case MN26-46871

6. Overturned 2026 · Medical necessity · age 51–64 UV light therapy systems · Skin The physician reviewer found that Nature of Statutory Criteria/Case Summary: A patient has requested authorization and coverage for ultraviolet B (UVB) light home phototherapy device, DermaPal, or Phothera 100. Current medical literature offers reasonable…

   The physician reviewer found that Nature of Statutory Criteria/Case Summary: A patient has requested authorization and coverage for ultraviolet B (UVB) light home phototherapy device, DermaPal, or Phothera 100. Current medical literature offers reasonable evidence supporting the utility of narrowband UVB in the treatment of vitiligo, including for use as home-based treatment. Per the medical records, the patient has tried and failed therapy with topical medications. In this clinical setting, given that current medical literature supports the use of a narrowband UVB home unit, UVB light home phototherapy device, DermaPal, or Phothera 100, is medically necessary for the treatment of this patient. Final Result: The reviewer determined that the requested equipment is medically necessary for the treatment of the patient's medical condition. Therefore, the Health Plan's denial should be overturned. Credentials/Qualifications: The reviewer is board-certified in dermatology and is actively practicing. The reviewer is an expert in the treatment of the patient's medical condition and knowledgeable about the proposed treatment through recent or current actual clinical experience treating those with the same or a similar medical condition.

   Case MN26-46867

7. Overturned 2026 · Medical necessity · age 41–50 Replacement batteries · Hormones and metabolism The physician reviewer found that Nature of Statutory Criteria/Case Summary: A patient has requested authorization and coverage for the FreeStyle Libre 3 Plus sensor. Reactive hypoglycemia is the condition of postprandially hypoglycemia occurring two to five…

   The physician reviewer found that Nature of Statutory Criteria/Case Summary: A patient has requested authorization and coverage for the FreeStyle Libre 3 Plus sensor. Reactive hypoglycemia is the condition of postprandially hypoglycemia occurring two to five hours after food intake. Symptoms of postprandial hypoglycemia include dizziness, fatigue, diaphoresis, and weakness. These symptoms usually occur after ingesting a carbohydrate-rich meal and are associated with documented hypoglycemia. In this case, the patient has a history of chronic postprandial hypoglycemia. The patient was found to be a carrier of CDH1 mutation, which confers and increases the risk of gastric cancer. As such, the patient underwent prophylactic gastrectomy. The patient has previously used a continuous glucose monitor (CGM), which is noted to have been effective. Numerous studies support the use of a CGM in patients with non-diabetic hypoglycemia. According to one study, real-time CGM data and alarms can help decrease instances of low sensor glucose, high sensor glucose, and glycemic variability. The authors found that a CGM enables users to identify post-meal hyperglycemic spikes and impending hypoglycemia, allowing them to adjust their diet or self-treat to prevent low blood sugar episodes. The authors suggested that CGM devices may enhance safety in post-bariatric hypoglycemia, especially for those with reduced awareness of hypoglycemia. Another study showed that the use of unblinded CGM in patients with reactive hypoglycemia reduces frequency and severity of hypoglycemia and improves quality of life by decreasing hypoglycemia-related worries and enabling a less restrictive diet. The authors reported that a CGM should be considered a first-line treatment for patients with post-bariatric hypoglycemia. Notably, recurrent chronic hypoglycemia is detrimental to end organs such as the brain, heart and kidneys. In summary, continuous glucose monitoring provides data and alerts that enable patients to detect early signs of declining glucose levels, allowing them to take preventative action before symptomatic hypoglycemia develops, thereby reducing end organ damage. Given these findings, the requested FreeStyle Libre 3 Plus sensor is medically necessary for the treatment of this patient. Final Result: The reviewer determined that the requested equipment is medically necessary for the treatment of the patient's medical condition. Therefore, the Health Plan's denial should be overturned. Credentials/Qualifications: The reviewer is board-certified in endocrinology, diabetes, and metabolism and is actively practicing. The reviewer is an expert in the treatment of the patient's medical condition and knowledgeable about the proposed treatment through recent or current actual clinical experience treating those with the same or a similar medical condition.

   Case MN26-46823

8. Upheld 2026 · Medical necessity · age 51–64 Power operated vehicles · Bones, joints and muscles The physician reviewer found that Nature of Statutory Criteria/Case Summary: A patient has requested authorization and coverage for use of a power scooter. In this case, the patient has decreased mobility with a history of low back pain and muscle spasm, as…

   The physician reviewer found that Nature of Statutory Criteria/Case Summary: A patient has requested authorization and coverage for use of a power scooter. In this case, the patient has decreased mobility with a history of low back pain and muscle spasm, as well as knee pain and osteoarthritis with prior knee arthroplasty requiring revision surgery. However, the records do not sufficiently document that the patient requires a power scooter for mobility and performing daily activities of living in the home or community setting. The patient requires standby assistance for performing transfers and ambulating with a cane. The medical records do not support that the patient cannot use a cane or walker for assistance with ambulation or propel a manual wheelchair for mobility. Moreover, the records lack documentation that the patient can safely transfer to and from the requested power scooter, can operate it safely, and that the patient’s home is accessible for the requested power scooter. Given these findings, the requested use of a power scooter is not medically necessary for this patient to perform one or more mobility-related activities of daily living or instrumental activities of daily living in or out of the home, including access to the community. Final Result: The reviewer determined that the requested equipment is not medically necessary for the treatment of the patient's medical condition. Therefore, the Health Plan's denial should be upheld. Credentials/Qualifications: The reviewer is board-certified in physical medicine and rehabilitation and is actively practicing. The reviewer is an expert in the treatment of the patient's medical condition and knowledgeable about the proposed treatment through recent or current actual clinical experience treating those with the same or a similar medical condition.

   Case MN26-46804

9. Upheld 2026 · Medical necessity · age 51–64 Stimulation devices · Brain and nerves The physician reviewer found that Nature of Statutory Criteria/Case Summary: A patient has requested authorization and coverage for a functional electrical stimulator thigh cuff to go along with the existing Bioness L300 Go. In this case, the patient has a…

   The physician reviewer found that Nature of Statutory Criteria/Case Summary: A patient has requested authorization and coverage for a functional electrical stimulator thigh cuff to go along with the existing Bioness L300 Go. In this case, the patient has a history of a traumatic brain injury (TBI) with left-sided weakness and foot drop. A Bioness L300 functional electrical stimulation device without the requested functional electrical stimulator thigh cuff was provided to help with the patient’s foot drop and ambulation. It is understandable that the functional electrical stimulator thigh cuff is being requested, given the patient's use of the Bioness L300 functional electrical stimulation device for the foot drop and weakness. However, there is insufficient clinical evidence supporting the efficacy of the Bioness L300 functional electrical stimulation device with the thigh cuff. As such, the requested functional electrical stimulator thigh cuff to go along with the existing Bioness L300 Go is not medically necessary for the treatment of this patient. Final Result: The reviewer determined that the device is not medically necessary for the treatment of the patient's medical condition. Therefore, the Health Plan's denial should be upheld. Credentials/Qualifications: The reviewer is board-certified in physical medicine and rehabilitation and is actively practicing. The reviewer is an expert in the treatment of the patient's medical condition and knowledgeable about the proposed treatment through recent or current actual clinical experience treating those with the same or a similar medical condition.

   Case MN26-46795

10. Upheld 2026 · Medical necessity · age 0–10 Hospital beds assoc supplies · Sym/Sign Ab Find The physician reviewer found that Nature of Statutory Criteria/Case Summary: The patient’s parent has requested authorization and coverage for a Cubby Bed.Customized hospital beds may be medically necessary for patients with mobility limitations, positioning…

    The physician reviewer found that Nature of Statutory Criteria/Case Summary: The patient’s parent has requested authorization and coverage for a Cubby Bed.Customized hospital beds may be medically necessary for patients with mobility limitations, positioning requirements, or the need for specialized attachments or elevation of the head of the bed. Additional safety features, including enclosed beds, may be considered in select patients with significant cognitive impairment, behavioral dysregulation, or safety concerns such as falls or elopement.Enclosed beds such as Cubby Beds are generally reserved for refractory cases involving severe sleep or behavioral disturbances that do not respond to environmental modification or behavioral interventions. In this case, the patient has cerebral palsy with dysphagia and respiratory concerns requiring positioning at an angle while in bed. The parent reports concern regarding entrapment risk in a standard bed.However, the records do not document that the patient is independently mobile, capable of elopement, or otherwise at significant risk requiring an enclosed bed system. The records also do not establish why alternative medical beds capable of angular positioning would be insufficient to meet the patient’s clinical needs.Given these findings, the medical records do not sufficiently establish medical necessity for a Cubby Bed. Therefore, the requested Cubby Bed is not medically necessary for the treatment of this patient. Final Result: The reviewer determined that the requested equipment is not medically necessary for the treatment of the patient’s medical condition. Therefore, the Health Plan’s denial should be upheld. Credentials/Qualifications: The reviewer is board-certified in neurology with special qualification in child neurology and is actively practicing. The reviewer is an expert in the treatment of the patient’s medical condition and knowledgeable about the proposed treatment through recent or current actual clinical experience treating those with the same or a similar medical condition.

    Case MN26-46731

11. Upheld 2026 · Medical necessity · age 31–40 Wheelchairs power operated · Skin The physician reviewer found that Nature of Statutory Criteria/Case Summary: A patient has requested authorization and coverage for the use of a power wheelchair with power seat elevation. Review of the medical records establishes that the patient has…

    The physician reviewer found that Nature of Statutory Criteria/Case Summary: A patient has requested authorization and coverage for the use of a power wheelchair with power seat elevation. Review of the medical records establishes that the patient has pyoderma gangrenosum with extensive ulceration and edema of the distal bilateral lower extremities. The patient is nonambulatory and currently uses a Group 3 power wheelchair with power tilt, recline, and elevating leg rests for mobility.The patient requires moderate to maximum assistance with transfers, pressure relief, and repositioning. The records indicate that the patient’s current wheelchair is approximately three years old, and wheelchair evaluation was completed on 09/05/25. The current wheelchair configuration adequately meets the patient’s mobility, seating, and positioning needs and can be repaired if necessary.Although the requested addition of power seat elevation was considered, the records do not establish that this feature would significantly improve the patient’s independence with transfers, reduce risk of shear injury or pressure injury, or meaningfully reduce fall risk. The patient would continue to require assistance with transfers despite the requested feature.Given these findings, the requested power wheelchair with power seat elevation is not medically necessary for the patient to perform mobility-related activities of daily living or instrumental activities of daily living in or outside the home. Final Result: The reviewer determined that the requested device is not medically necessary for the treatment of the patient’s medical condition. Therefore, the Health Plan’s denial should be upheld. Credentials/Qualifications: The reviewer is board-certified in physical medicine and rehabilitation and is actively practicing. The reviewer is an expert in the treatment of the patient’s medical condition and knowledgeable about the proposed treatment through recent or current actual clinical experience treating those with the same or a similar medical condition.

    Case MN26-46705

12. Upheld 2026 · Medical necessity · age 51–64 Replacement batteries · Sym/Sign Ab Find The physician reviewer found that a patient has requested authorization and coverage for a Dexcom G7 continuous glucose monitor (CGM) system. The patient currently presents with prediabetes, defined by a hemoglobin A1c level below 6.5% while not taking…

    The physician reviewer found that a patient has requested authorization and coverage for a Dexcom G7 continuous glucose monitor (CGM) system. The patient currently presents with prediabetes, defined by a hemoglobin A1c level below 6.5% while not taking prescription medications for diabetes control, and manages this condition with diet and lifestyle choices. The patient has experienced low glucose readings when wearing a CGM. The American Diabetes Association recommends CGM use for adults with diabetes who use insulin, as insulin therapy increases the risk of hypoglycemia and real‑time alerts can be beneficial. However, CGMs are not recommended for individuals with prediabetes or for evaluation of hypoglycemia in individuals without diabetes. Low glucose readings can occur in people without diabetes and often reflect normal physiologic variation rather than true hypoglycemic pathology. In the absence of diabetes or insulin use, CGM monitoring is not recommended for evaluation of these findings. Given these considerations, the requested Dexcom G7 CGM system is not medically necessary for the evaluation of this patient. Final Result: The reviewer determined that the requested device is not medically necessary for the evaluation of the patient's medical condition. Therefore, the Health Plan's denial should be upheld. Credentials/Qualifications: The reviewer is board-certified in endocrinology, diabetes, and metabolism and is actively practicing. The reviewer is an expert in the treatment of the patient’s medical condition and knowledgeable about the proposed treatment through recent or current actual clinical experience treating those with the same or a similar medical condition.

    Case MN26-46608