Dealing with health insurance is rarely simple, especially when you’re trying to get a mobility device covered. For many families, equipment like an electric wheelchair isn’t optional, so when an insurance company sends a denial letter, it feels overwhelming and unfair.

The good news is that denials can often be appealed successfully. Understanding why a request was denied and how to respond gives you a much better chance of turning that “no” into a “yes.” This guide will walk you through the most common denial reasons and what you can do to strengthen your appeal. Here’s what you need to know.

Key Takeaways:

  • Insurance denials for mobility devices are often caused by missing documentation or policy limitations.
  • A strong appeal depends on detailed medical notes and understanding exactly what the insurance company needs.
  • Persistence matters; many approvals happen on second-level appeals or after additional documentation is submitted.

Why Wouldn’t Insurance Cover a Wheelchair or Mobility Device?

Insurance denials usually boil down to a few predictable issues:

Medical Necessity

Insurance companies want proof that the device is medically necessary, not just helpful. If the documentation doesn’t clearly explain why the equipment is essential for daily mobility or safety, they may deny it.

Policy Limitations

Some insurance plans only cover basic devices or exclude certain features. Others may not cover powered mobility at all unless specific criteria are met. 

Alternative Solutions

Some insurers insist that a manual wheelchair or other device should be tried at first, even if it’s not realistic for your or your loved one’s abilities.

Incomplete Documentation

Even small gaps (e.g., missing forms, unclear notes, or outdated evaluations) can lead to a denial. Insurance reviewers will not make assumptions; they only go by what they have in front of them. Also, something as simple as the wrong billing or diagnosis code could result in an automatic refusal.

What Medical Conditions Typically Qualify for an Electric Wheelchair?

While every case is reviewed individually, certain conditions tend to meet coverage criteria more easily because they clearly limit mobility. Neuromuscular disorders like Amyotrophic Lateral Sclerosis (ALS), muscular dystrophy, and Spinal Muscular Atrophy (SMA) often require power wheelchairs since strength and coordination decline over time. Children or adults with severe arthritis may also struggle to self-propel a manual wheelchair, which would make an electric wheelchair a safer, more realistic option.

Finally, spinal cord injuries frequently qualify, especially when the individual’s mobility depends on powered support rather than upper body strength.

What to Do If Your Electric Wheelchair or Accessories Are Denied

The first step after a denial is to read the denial letter carefully. It will explain exactly why the claim was rejected, and that reason will become the roadmap for your appeal. After that, call your insurance provider directly to avoid unnecessary back-and-forth and ask what documentation they’re looking for.

Next, you’ll want to connect with your healthcare provider to gather everything the insurer needs (e.g., updated notes, detailed evaluations, letters of medical necessity, anything else that paints a clear picture of daily mobility challenges). Having thorough documentation should make a noticeable difference when your claim is reviewed again.

How Does the Prior Authorization Process Work and Why Do Delays Happen?

Before most mobility devices are approved, a prior authorization request (PAR) has to be submitted. Prior authorization is basically the insurance company giving a pre-approval before a mobility device is ordered.

How It Works

Your provider (or mobility equipment supplier) sends detailed paperwork explaining your medical condition and why the device is necessary. From there, the insurance company often asks for more information, which can lead to emails, calls, and extra documentation, which alone can take several weeks.

Common Delay Reasons

Delays can happen for a variety of reasons, including, but not limited to:

  • Missing or incomplete clinical notes
  • Requests for updated evaluations
  • High review volume at the insurance company

Unfortunately, even a well-prepared prior authorization can take anywhere from two to eight weeks to process.

How Can I Appeal an Insurance Denial for a Mobility Device?

Every insurance plan has its own appeals process, so the first step is reviewing those guidelines. These are usually listed on their website or explained in your denial letter. Your appeal letter should explain why the denial is incorrect and how the equipment will ultimately improve your independence and quality of life, and it should be supported by medical records.

Once the appeal is submitted, try to follow up regularly. Insurance companies handle a large volume of requests, and checking in can help prevent your appeal from getting lost or delayed. It may also help to keep notes on who you spoke with and when. 

How Can I Increase My Chances of a Successful Appeal?

While you can’t control how fast insurance companies move, you can improve the strength of your case if it’s initially denied. Here are a few ways to do just that:

  1. Work Closely with Healthcare Providers: As mentioned above, the strongest appeals rely on detailed, accurate medical documentation. Ask your providers to be as specific as possible about why the equipment is medically necessary.
  2. Stay Persistent: Persistence also goes a long way. If the first appeal is denied, you may still have the option for a second-level appeal or an external review. Many families don’t realize they can keep pushing and that many approvals happen on later attempts.
  3. Educate Yourself: The more you understand your own insurance policy, the better you can advocate for yourself. Knowing the terminology and common sticking points can help you anticipate what the insurance company needs to see.

Have Questions About Mobility Devices? Contact Us

Appealing an insurance denial can feel discouraging, but you’re not out of options. With the proper documentation and a little persistence, many denials can be successfully overturned. You don’t have to navigate the process alone, either.

If you need help gathering documentation or choosing the right mobility device, our team of certified Assistive Technology Professionals is here to support you every step of the way. Contact us today or call 800-980-5696 for your free consultation; we’re happy to help you get the equipment you need!