Insurance Coverage for Durable Medical Equipment

durable medical equipment DMEDurable medical equipment refers to any specialized piece of medical equipment that a doctor prescribes for a patient to use at home. It must be able to be used on a long-term basis, be medically necessary, and not be useful to a person who is not ill or injured.

Even though hygiene is an extremely important part of life, Medicare and many private insurance companies consider bathing and showering equipment conveniences, not medical necessities, and deny DME claims. However, with persistence you can get funding for the equipment you need.

Congress has been tightening restrictions on Medicare’s DME reimbursements in an effort to cut costs. Medicare often rejects claims for bathroom-related DME, but disability advocates recommend filing a claim anyway, along with a prescription and letter of medical necessity. If your claim is denied, you can appeal and possibly get the item covered, although the process can be lengthy.

Medicaid coverage for DME varies from state to state. Several states follow the Medicare guidelines related to durable medical equipment. Many Medicaid waivers provide some funding for various types of DME. Check with your caseworker or state Medicaid office to see if coverage is available.

If you are a veteran, you may be eligible for coverage for a shower chair or grab bars from the Department of Veterans Affairs if your doctor says the equipment is medically necessary. The VA also offers the Special Home Adaptation grant to veterans with service-related disabilities for home improvements to increase mobility. Grants of up to $10,000 are available for veterans who are permanently and totally disabled as a result of military service.

Private insurance companies vary in terms of coverage for DME, but the trend is toward following restrictive Medicare guidelines. However, some newer insurance companies are more likely to cover bathroom DME.

If your insurance claim for durable medical equipment is denied, you have the right to appeal. You may be able to get the decision reversed if you have a letter of medical necessity and a doctor who is willing to fight on your behalf. If you are persistent, your efforts may pay off and your equipment may be covered.

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