Getting your DME can be a challenging and time consuming process. Using the following information can help to make the process go a little faster, and reduce the chance of denial of coverage by your health insurance carrier.
It is important for you to take charge of getting your DME. You know best what you need and it is your responsibility to make sure you get equipment that will work for you. This process can go more smoothly if you attend to the details
- Who can get DME?
- What are the steps in getting DME paid for?
- What are the most common reasons for denial of payment?
What is Durable Medical Equipment?
According to the Centers for Medicare and Medicaid Services, is a health care device that helps a person with a mobility limitation to conduct activities in their home and community. This includes such items as wheelchairs, walkers, oxygen tanks, communication devices and hospital beds. The Centers for Medicare and Medicaid Services defines durable medical equipment as any equipment that:
- Can withstand repeated use
- Is not useful to a person who does not have an illness or injury
- Is appropriate for use in the patient’s home
It’s strange how they think we are all sick and stuck at home, and that getting around is a medical issue!
What Are Some Examples of DME?
DME is considered to include:
- Equipment that can help you to get around more easily such as canes, crutches, walkers, wheelchairs or scooters.
- Equipment that you may need to care for yourself at home such as hospital beds, raised toilet seats, oxygen tanks, or machines that make breathing easier.
- Equipment that can help you to hear or see better like hearing aids or magnifiers.
DME does NOT include:
- Equipment that is considered “items of personal convenience” or reusable items, such as rubber gloves, catheter tubing, or irrigation kits.
- Equipment that is not considered to be for “medical use,” such as grab bars, lifts or shower chairs.
- Equipment used exclusively outside of the home is often labeled recreational or “used to pursue leisure interests” and may not be covered as DME.
So getting around is a medical issue, but taking a shower is not?? Who writes these regulations?
Who can get DME?
People who are admitted to hospitals and skilled nursing facilities for surgeries, illnesses or injuries will get the equipment they need before being discharged. In these situations, the equipment that people receive depends on why they were in the hospital. For example, if you go to a hospital for a hip replacement, the hospital will probably send you home with a walker and a raised toilet seat.
The process for getting DME without being in the hospital is different. You can pay for any piece of durable medical equipment yourself. However, because it can be expensive, people usually use their health insurance to pay for DME. Insurance carriers have different guidelines for what equipment they will pay for. For example:
Medicare pays for DME when you:
- have Medicare part B;
- have a doctor prescribe a covered item of DME; and
- need the device in order to function in your home.
How Do You Get The DME You Need?
Once you have decide that DME is the right choice for you, there are several steps involved in getting it. If you are able to pay for the equipment yourself, you can go to any DME vendor in your area that has the equipment you would like and you can purchase it. Depending on whether it’s in stock and available, you may be able to pick up the DME immediately or usually within several weeks. Follow these steps to get your DME.
What is a DME vendor?
A DME vendor is a company that specializes in DME. DME vendors have staff who are experts in equipment. Some are physical therapists (PT), occupational therapists (OT) and Certified rehabilitation technology suppliers. The vendors work with the companies that make the equipment as well as your insurance carrier.
How do you find a DME vendor?
Your health insurance carrier may allow you to choose your own DME vendor. However, your insurance company may have a recommended DME vendor, and they may only pay for equipment you get through this vendor. Many times the DME vendor who has the contract for your insurance may not be the best qualified to handle your needs. Ask your insurance carrier what you may do if you are not satisfied with their vendor. You are the consumer!
If you have a choice of vendor:
- Your doctor can recommend a DME vendor.
- Ask your friends if they can recommend a DME vendor in your area.
- Telephone your local drug store, pharmacy or medical supply company and ask if they know of DME vendors in your area.
Who Follows Up On Your Order?
You do. To make sure everything has been filed and the process is going smoothly, you should follow up with your DME vendor. Remember, they handle hundreds of requests so you also will want to follow up with Medicare, Medicaid or your private insurance company directly to check on the status of your claim.
You should keep a copy of every form filed with your request and get any claim numbers and all contact information. Make sure your doctor knows also how long the process is taking and what is happening so that he/she will be able to assist you in following up when necessary.
Conclusion:
Getting the right gear for your unique needs can be a challenging and time consuming process. Using the information provided here and attending to the details can help make the process go a little more smoothly and reduce the chance of having your request denied. It is important that you take charge of getting your DME. It is your responsibility to make sure you get the right gear.
If you need any help in contacting DME Vendors Contact us. Our team will guide and support you with selecting of right DME suppliers for your Medical issues.
