Durable Medical Equipment, Orthotics, Medical Supplies, and Repairs/Replacements – Commercial and Individual Exchange Medical Policyopen_in_new

UnitedHealthcare covers physician‑ordered DME, orthotics, certain medical supplies and repair/replacement (e.g., ventilators/BiPAP/CPAP per clinical criteria, enteral/insulin pumps, select ostomy and urinary supplies, cochlear external components, orthotic braces, pediatric wheelchairs) when the item meets the plan’s medical‑necessity definition; excluded are comfort/convenience items, implanted devices claimed as DME, most home monitoring/diagnostic equipment, non‑medical mobility devices, and other specific exclusions listed. Key requirements: a physician order and documentation that InterQual/CMS/AASM criteria (where applicable) and plan medical‑necessity rules are met, evidence replacements are beyond the 5‑year RUL and irreparable (or repairs/upgrade justification), plus item‑specific documentation (e.g., catheter counts, pediatric growth allowances).

"Ostomy supplies are excluded unless specifically stated as covered (only specific ostomy supplies listed are covered)."