Durable Medical Equipment (DME) is referring to any medical equipment that is ordered by a provider. Such equipment can include; front wheel walkers, wheelchairs, canes, nebulizer equipment, oxygen, hospital beds, bedside commodes, shower chairs, and blood sugar machines just to name a few.
It is worth noting that some insurances cover 100% while others including Medicare only cover up to 80%. It would be wise to contact your insurance carrier and ask for a list of approved DME and any co pays associated with them. While in the hospital this can be checked with the help of the discharge planner.
Most insurance companies can cover the cost of DME if there is a credible medical need for the device.
To qualify for a wheelchair the physician or provider must document that the patient is unsafe to walk with a standard walker; a wheelchair is required to improve his or her participation in activities of daily living. The patient must also be willing to use the wheelchair in and out of the home. A caregiver or family member must be available to help patient in and out of the wheelchair.
The Physician or provider must document that the patient has an unsteady gait and is subject to falling. That a FWW would be needed to help prevent falls and improve the participation in activities of daily living. Per Medicare, one walker can be paid for in each 5-year period.
A sleep study or its’ equivalent is required by most insurance to qualify for a CPaP machine.
To qualify for Oxygen an individual must demonstrate an O2 saturation of 88% or lower while not on supplemental Oxygen and a pulmonary disease diagnosis.
The patient must have a reason to have the head of bed greater than 30 degrees while in bed due to either a pulmonary or cardiac condition. Other reasons are:
A. To help prevent aspiration due to a problem with swallowing.
B. Pain alleviation.
C. Patient needs to be re positioned every 2 hours, due to weakness, to prevent bed sores.
**Medicare pays for a semi-electric bed.
Patient must be confined to a room at night and poses a fall risk walking to the bathroom or is confined to a room with no adjacent bathroom or not confined in a room that has no bathroom on the same level as the room.
**If insurance will not pay for these items there is an alternative. Medical equipment can be found at an affordable rate at your local drug or retail store. Another place to look is ebay™, Amazon™, or a variety of apps that sell second hand equipment. Thrift stores and garage sales are another good option.
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