At UnitedHealthcare's discretion, prosthetic devices may be covered for damage beyond repair with normal wear and tear, when repair costs are more than the cost of replacement or when a change in the covered member's medical condition occurs sooner than the three year timeframe. Replacement of artificial limbs or any part of such devices may be covered when the condition of the device or part requires repairs that cost more than the cost of a replacement device or part.
Benefits are limited to a single purchase (including repair/replacement) every three calendar years.
Prior Authorization Requirement
For out-of-network benefits you must obtain prior authorization from UnitedHealthcare before obtaining prosthetic devices that exceed $1,000 in cost per device. If prior authorization is not obtained as required, benefits will be subject to a $400 penalty.