Does Your Health Insurance Cover Durable Medical Equipment?
DME coverage varies by state, but many Medicaid programs offer coverage. Most plans require a doctor's prescription or justification.
Durable Medical Equipment (DME) is a medical equipment that helps patients suffering from a debilitating illness or injury live a more normal life at home. This equipment includes hospital beds, walkers, and wheelchairs. Many health insurance companies, such as Medicare, will cover the cost of this equipment. However, the patient will need a physician’s prescription for it. This will ensure that the insurance company will reimburse them for the costs of the DME. Typically, Durable Medical Equipment includes devices with an expected lifespan of three years or more that serve a medical purpose. This includes items like oxygen tanks and wheelchairs. But other equipment, such as personal hygiene products and disposable bandages, doesn’t qualify as Durable Medical Equipment because they only have a short life span and don’t serve a medical purpose.
The qualifying process varies by state. However, it generally starts with a doctor writing a prescription or letter for the DME. Then, the patient will take this letter to a DME supplier that is enrolled in Medicaid. The supplier will then submit a prior authorization request to Medicaid. If the request is approved, then the DME will be mailed to the patient. If it is denied, the patient will receive a letter explaining why and information on how to appeal the decision.
What is Non-durable Medical Equipment?
Specialized medical equipment and supplies help a person with a debilitating injury, illness, or disability live a better life at home. This service covers both durable equipment, such as shower chairs and walkers, and non-durable equipment and supplies, which are disposed of after use and serve only a medical purpose. The person’s service and support administrator, or SSA, assesses whether they need specialized medical equipment and supplies to accomplish daily activities. The SSA may pay for the equipment, controls, appliances, and supplies specified in the person’s individual service plan as necessary to accomplish the goals listed in the plan. Equipment is generally provided through a private contractor.
Medical supply companies that accept assignment from Medicare — meaning they agree to cover the Medicare-approved amount — are known as participating suppliers. Choosing the right supplier is essential because non-participating suppliers aren’t eligible for reimbursement. Developing standard templates and designating staff experts to shepherd Durable Medical Equipment orders through the process can increase a practice’s efficiency, cutting costs and improving patient care.