Everything You Need to Know About Durable Medical Equipment (DME)

durable medical equipment

It’s not just older people who need durable medical equipment.  After surgery, mobility aids are often needed.  Also, people with chronic illnesses or disabilities require the support of DME.

But a lot of people aren’t clear about what it is.  So, we’ve assembled this handy guide with everything you need to know about durable medical equipment (DME) and how it helps so many with mobility and other medical needs.

What Is It?

DME is defined as material medical aids which provide therapeutic support for illnesses and medical conditions of various kinds.

To be classified as DME, the supports in question must meet the following criteria:

  • Represent benefit to someone with a specific condition/illness
  • Be prescribed by a medical professional
  • Not be sought for the sake of convenience or as a comfort
  • Not be sought for purposes other than medical

These criteria must all be met for the equipment to be covered by Medicare or other types of insurance and the cost of purchase or rental reimbursed.  For example, the reasons you seek out a piece of equipment must be valid medical ones.

Will I Be Covered?

Insurers handle DME coverage variously.  In the case of Medicare, there is a wealth of information online concerning what’s covered and what’s required in terms of documentation.  But working closer with your doctor and DME provider, you can improve your chances of approval.

Much depends on the following conditions:

  • Your physician and any physical therapist assisting you, as well as the supplier, being diligent about providing the correct documentation to be given to your insurer.
  • Whoever’s funding your DME will review the documentation to determine whether it’s medically necessary, so bullet point one is extremely important.

But if you live in a Medicare Competitive Bidding city (enter your zip code here to determine whether you do and to see a list of suppliers accredited under the program), you are compelled to order from a Medicare supplier.

If you’re scheduled for surgery or have recently developed a condition requiring the support of DME, it’s crucial that you speak with your physician about your post-surgical needs, or newly-acquired condition and what you’ll require in terms of DME.

As stated earlier, insurance companies vary enormously in terms of what they’ll reimburse you for, so being aware of their rules and requirements is valuable information.

Big Ticket Items

Expensive DME like electric wheelchairs are supports to be prized.  Remember, when you get one of these and it’s covered, it’s like a lifeline and a part of your body that’s going to help you get around.

That means you’ll need to maintain it, to ensure that it’s operational until the approved replacement period has elapsed.  With Medicare that’s between 5 and 7 years.

Most insurers will pay for routine maintenance of these items, so be sure to read the fine print and understand the regulations in this regard.

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Obility’s mission is to give you whatever will help you get better.  Let us join you on the journey toward whatever better means for you.

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