Is All Durable Medical Equipment Covered by Insurance?

[caption id="attachment_840" align="alignright" width="279"] image credit: advcr.com[/caption] The simple answer is no. Medicare Part B (medical insurance) covers medically necessary durable medical equipment (DME) that your doctor prescribes for use in your home. Your physician, nurse practitioner (NP), physician’s assistant (PA) or certified nurse specialist (CNS) can prescribe medical equipment for a patient. Medicare is considered the driver when it comes to coverage criteria for durable medical equipment and all other insurance companies typically follow their guidelines. Acceptable durable medical equipment must meet these criteria:

• Durable and can withstand repeated use
• Used for a medical reason
• Would not be useful to a person who is not sick or injured
• Used in the home
• Expected lifetime of at least 3 years

Durable medical equipment is defined as certain medical equipment, such as a walker, wheelchair, or hospital bed, that is ordered by a doctor for use in the home. Also referred to as home medical equipment (HME), oxygen equipment and CPAP supplies and accessories are included in the group of covered items. Durable medical equipment Medicare will cover includes, but is not limited to:

• Blood sugar monitors & test strips
• Canes (not including white canes for the blind)
• Commode chairs
• Crutches
• Hospital beds
• Manual wheelchairs and power mobility devices
• Nebulizers and nebulizer medications
• Oxygen equipment and accessories
• Sleep apnea and Continuous Positive Airway Pressure (CPAP) devices and accessories
• Walkers

Medicare has changed the way it reimburses for durable medical equipment. Prior to the Prescription Drug Act of 2003, paperwork could be completed after the patient received the equipment and any provider could be used, but now all paperwork must be completed and approved prior to receiving equipment and only providers with a Medicare Competitive Bid can be used. Additionally, the patient must meet certain coverage criteria for the item. If the specific criteria are not met, insurance will not cover the item. Insurance companies have tightened the reigns on requirements for durable medical equipment and simply requesting a physician to write a letter for coverage is no longer a viable option. For an insurance company to cover a specific piece of medical equipment, the patient must complete each of the following:

1. Meet the coverage criteria for the particular piece of equipment.
2. Provide a detailed, written order from a physician, nurse practitioner, physician’s assistant or certified nurse specialist to the DME provider.
3. Provide a note from the above clinician to the DME provider confirming an in-person visit as well as a discussion about the need for specific medical equipment took place.
4. Provide any necessary documentation supporting the need for the specific equipment.

Insurance dictates that no medical equipment can leave the showroom or warehouse until the DME provider has all of the above documentation first. If the DME provider does not obtain the documents, insurance will not cover the item and the patient will be responsible for payment. Although Liberty Oxygen and Medical Equipment is not a competitive bid provider, we assist our customers each day with questions and point them in the direction of the providers in the Minneapolis and St. Paul metro area. Liberty Oxygen has a list of local providers for reference and the www.medicare.govwebsite provides up-to-date, important information. The ability to search the list of local and national competitive bid providers is available on the Medicare website by entering your zip code and the item needed. Be aware if you are searching for a provider using the Medicare website, some providers appear to be local to Minneapolis and St. Paul metro area even if they are not. This is because the provider will ship items and this can be costly. Liberty Oxygen and Medical Equipment is the premier oxygen and home medical equipment provider serving Minneapolis, St. Paul and the surrounding Twin Cities suburbs with quality equipment and outstanding customer service. We enable you to stay safe and live independently in your home by offering a comprehensive array of home medical equipment and oxygen, including a walker, cane, and shower grab bars which may help with balance issues. Your health and well-being is too important to trust to just anyone. Let the caring professionals at Liberty Oxygen and Medical Equipment assist you with the home medical equipment and other healthcare and oxygen supplies you need. Stop in any of our eight Minneapolis and St. Paul metro locations or contact us today with questions, concerns or comments.