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Real members of mySMAteam have posted questions and answers that support our community guidelines, and should not be taken as medical advice. Looking for the latest medically reviewed content by doctors and experts? Visit our resource section.

Does anyone know how to get a brace that insurance covers? I have United Healthcare through my husband's employer, Medicare A & B.

A mySMAteam Member asked a question 💭
Waterloo, IA

I have paid, out of my own pocket, for 2 specialty braces: over $6000! United Healthcare keeps denying my claims. I send all the documentation I have. Four times I've been denied. 🥺

May 18
 · 
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A mySMAteam Member

I should explain that I have Autosomal Dominant Polycystic kidney disease. I am Stage 4 renal failure. My Nephrologist tells me that I have stabilized.

May 18
A mySMAteam Member

I have done all of your recommendations. I have Levoscoliosis (50 degee bend). I keep getting "not medically necessary"'even though my Primary doctor, Neurosurgeon & Brace company have sent "Medically necessary" letters along with my claims. Ugh

May 18
mySMAteam

That is incredibly frustrating, and $6,000 out of pocket is a serious financial burden. Four denials is a lot to push through, but it doesn't mean the fight is over — there are still steps that can help.

First, it's important to understand *why* the claims are being denied. Call United Healthcare directly and ask them to Show Full Answer

That is incredibly frustrating, and $6,000 out of pocket is a serious financial burden. Four denials is a lot to push through, but it doesn't mean the fight is over — there are still steps that can help.

First, it's important to understand *why* the claims are being denied. Call United Healthcare directly and ask them to explain the exact reason for each denial. Common reasons include:

- The brace is considered "not medically necessary"
- It's being coded incorrectly by the provider
- The supplier is out-of-network
- The item isn't covered under your specific plan Once the reason is clear, a formal appeal can be built around it. For example, if the denial is due to "not medically necessary," your doctor can write a detailed letter explaining exactly why the brace is essential for managing SMA symptoms.

A strong appeal letter should include:

- The specific reason the brace is needed for SMA
- A physician's order or statement of medical necessity
- References to your policy's coverage language
- Supporting letters from additional doctors if possible Since United Healthcare has denied the claim four times, requesting an external review is a strong next step. This means an independent third party — not the insurance company — reviews the denial and makes a decision.

Also, since you have both United Healthcare and Medicare, it's worth checking whether Medicare could be billed as a secondary payer to help cover costs.

Organizations like Cure SMA or the Muscular Dystrophy Association can also help navigate insurance challenges and may connect you with advocates experienced in exactly this kind of situation.

May 18

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