Appeal: equipment or supplies
Asks your plan to cover medical equipment or supplies it denied, using your plan's own wording, your prescriber's order and how the equipment is used in your daily life.
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- A template, not legal advice
This one is for a specific kind of coverage
It is written for the coverage tagged above. If you have a different kind (for example Medicare or Medicaid instead of a job-based or individual plan), it may cite the wrong rules. Check what kind of coverage you have and use the letter written for it.
When to use this, and what it is not
When to use this. Use this when your plan denied medical equipment or supplies such as a wheelchair, a monitor or a brace. Have the prescription, your prescriber's notes and your plan's wording on equipment in front of you.
This is a template, not legal advice. Read it, change anything that is not true for you, and send it only when you are satisfied. Your notice and your plan document control.
Fill in the letter
Your letter
[Your name] [Your address]
13 November 2026
[Name and address of the plan's appeals department]
Re: Appeal: equipment or supplies Plan: [Name of the health plan] Member ID: [Member ID] Claim or reference number: [Claim or reference number]
To the reviewer:
I am appealing the decision dated [Date on the denial notice] on claim [Claim or reference number], which denied [The care or drug that was denied] from [Doctor, hospital or pharmacy] under [Name of the health plan], member ID [Member ID]. The equipment or supplies were ordered by [Who ordered the equipment, and the date of the order]. I ask you to reverse that decision and approve and pay for them.
The plan gave this reason: [The reason the plan gave] My plan's wording on this kind of equipment is: [Your plan's wording on this kind of equipment] I ask the plan to show which part of that wording it says my equipment does not meet.
Why I need it: [How the equipment helps your health and daily life]
What I use or have tried instead: [What you use or have tried instead]
I ask the plan to identify the criteria or coverage policy it applied to this equipment for my diagnosis, and to explain how my records were measured against it.
Under the federal claims and appeals rules, including Title 29 of the Code of Federal Regulations (CFR), sections 2560.503-1 and 2590.715-2719 (for individual coverage, 45 CFR 147.136), I am entitled to a full and fair review. I ask that someone who was not involved in the first decision, and who is not that person's subordinate, decide this appeal and give no deference to the first decision. If the decision rests on a medical judgment, I also ask that you consult a health care professional with training and experience in the field of my condition who was not consulted on the first decision. Please consider every record and comment I send, including anything that was not before the first reviewer.
Please send me your decision in writing within the time the rules allow. If you uphold the denial, I will ask for external review by an independent organization and may complain to the agency that regulates my plan.
Enclosures: 1. Copy of the denial letter 2. The prescription or order 3. Letter from my prescriber explaining why I need the equipment 4. Relevant pages of my medical records 5. The pages of my plan document on equipment
Sincerely, [Your name]
Before you send it
Send it to the appeals address printed on your denial notice, by a method that proves delivery, such as certified mail with a return receipt or the plan's online portal with a saved confirmation page. Keep a complete copy of the letter and everything you enclose, and write down the date and the method you used.
What to enclose
- Copy of the denial letter
- The prescription or order
- Letter from my prescriber explaining why I need the equipment
- Relevant pages of my medical records
- The pages of my plan document on equipment
What happens next
- Your plan must decide within 30 days after it receives your appeal if the care has not happened yet, or within 60 days if you have already had it. If your plan has two appeal levels, each level gets half that time. Check the date on your notice, which controls.
- Ask your prescriber to write a letter that says what the equipment does for you, what you have tried instead, and what happens without it. Send it to the plan if you have not already.
- If the plan says no again, or does not answer in time, ask for external review (also called independent review), which is a review by reviewers outside the plan. For most job-based and individual plans you have at least four months after you receive the final denial to ask. Check the date on your notice, which controls.
- You can also complain to the agency that oversees your plan. A complaint does not stop your appeal deadline, so file the appeal first.
- If you are writing for someone else, tick "I am writing for someone else". The plan may require its own authorization form. See the letter "Name someone to act for you".
The rule behind this
- 29 CFR 2560.503-1, claims procedure
- 29 CFR 2590.715-2719, internal claims and appeals and external review
- 45 CFR 147.136, internal claims and appeals and external review
- 29 U.S.C. 1185b, Women's Health and Cancer Rights Act
- 42 U.S.C. 300gg-27, Women's Health and Cancer Rights Act for individual coverage
Sources
- 29 CFR 2560.503-1, claims procedure
- 29 CFR 2590.715-2719, internal claims and appeals and external review
- 45 CFR 147.136, internal claims and appeals and external review
- 29 U.S.C. 1185b, Women's Health and Cancer Rights Act
- 42 U.S.C. 300gg-27, Women's Health and Cancer Rights Act for individual coverage
Denial reasons this answers
- Denial reason
Not medically necessary
The plan says the care is not needed under its own definition. That is a medical judgment, so your doctor's letter carries the appeal. Independent external review is open if your plan is not grandfathered, short-term, fixed indemnity or a sharing ministry.
- Denial reason
Not a covered benefit
The plan says your policy does not cover this service. Read the exact exclusion, check whether the service really falls inside it, and check whether a law requires the plan to cover it anyway.