What is durable medical equipment
and is it covered by my insurance?
• BY CATHY STUTZNEGGER GENERAL MANAGER, PACIFIC COAST MEDICAL SUPPLY
D
urable medical equipment is designed
to help people meet their medical needs
within their home. There are several
different types of equipment available
depending on the person’s needs.
Durable medical equipment is usually a major
medical benefit within most insurance companies.
All insurance companies follow a basic set of
guidelines for coverage with some insurances
requiring authorization. Here are some examples
of different types of equipment:
Manual Wheelchairs
There are many different styles of manual. The
three most common are standard, hemi, and
lightweight. The standard wheelchair is the most
common wheelchair that is used for short term use.
A hemi wheelchair is similar to the standard, but it
sits lower to the ground to allow for foot propulsion
or someone who is shorter in stature. A lightweight
wheelchair is for someone who doesn’t have as
much strength and endurance to self-propel a
standard wheelchair.
Walkers
There are two common types of walker, a front-
wheeled walker and a four-wheeled walker with
seat, brakes and basket. Most people who choose
the four-wheeled walker do not have as much
endurance and require frequent stops where they
need to sit and rest. Generally the brakes and
basket are not covered by insurance and the person
has a small copay.
Bedside Commodes
A bedside commode will either be a fixed arm
or drop-down arm. The difference is the drop-
down arm commode allows the arms to be moved
out of the way for someone who is unable to stand
and transfer but instead needs to slide on to the
commode.
Hospital bed
For any equipment to be covered by insurance,
there are basic steps that need to be followed. Here
are some of those steps:
The two most common types of hospital beds
are a semi-electric hospital bed and a full-electric
hospital bed. The semi-electric hospital bed allows
the head and the foot of the bed to be adjusted by
a remote control and the base height from the floor
by a manual crank handle. The full-electric hospital
bed will allow all of these adjustments to be made
by the remote control. Generally a full-electric
hospital bed is not covered by insurance and the
person has an upgrade charge.
Step 1: The person must have an in-person,
face-to-face exam with their doctor to specifically
discuss the need for the equipment they are
requesting. During this visit, the person will need
to discuss with the doctor why they need this
equipment. If the doctor agrees the person needs
the equipment, they will normally write a
prescription to be taken or faxed to a durable
medical equipment supplier.
14 • GOOD HEALTH 2016
Step 2: Once the prescription is received by the
supplier, they will verify if it is a covered item by
the insurance, if there is an authorization required
and if the person will have any out-of-pocket
expense. If an authorization is required, the
supplier will request the chart notes from the face-
to-face exam and fax them to the insurance to help
justify the need for the equipment.
Step 3: After the insurance has authorized the
equipment, it will be dispensed to the person.The
person will be informed on the proper use and
safety guidelines for the equipment.