One of the most common questions our medical equipment team gets asked is “does my insurance pay for home medical equipment?” Home medical equipment (HME), also known as durable medical equipment (DME), is typically covered by most insurance providers in some way, but the answer is more complicated than yes or no.
Does Insurance Cover Medical Equipment?
Whether or not a piece of medical equipment you need is covered by insurance is primarily dependent on your insurance provider. You can consult your healthcare policy or contact your insurance provider to find more details on specific products.
If your provider covers the items you need, you will then need to find a retailer who bills your provider. Many retailers bill insurance companies, but most retailers don’t bill every provider. Call the retailer before you go to make a purchase—it could save you a lot of time!
Some insurance plans will only cover specific medical products or manufacturers. This means that if you want to get a particular wheelchair (for instance) your insurance may only pay for a wheelchair made by a specific brand.
Every insurance plan is different. To get more detailed answers on what is covered by your plan, contact your provider with any questions.
Does Insurance Cover All Home Medical Equipment?
This question can also be answered more specifically by your insurance provider. Many plans and providers will offer some form of coverage for the following pieces of equipment.
- Rollators & Walkers
- Wheelchairs
- Hospital beds, mattresses, & accessories
- Power Mobility products
- Aids to Daily Living
- Post-op/Post-procedure aids
- Some lift mechanisms
The above list is not comprehensive, however, and may not apply to your insurance plan as every provider is different. If you are looking into getting reimbursed for any type of electric or motorized piece of medical equipment make sure to ask what your insurance provider specifically covers.
Some insurance providers only cover parts of electric/motorized equipment like the motor or lift mechanism. This means that a person using insurance to pay for a scooter where only the motor is covered would not be reimbursed for anything except the motor itself. Values on medically-necessary parts change from provider to provider.
Is a Prescription Required to Bill Medical Equipment to Insurance?
Most of the time a prescription for a specific piece of medical equipment is not required to bill your insurance company. You will want to speak to a representative before submitting any equipment-related billing so you know if the product you need is covered or not.
In some cases, like for certain custom pieces of medical equipment, a prescription may be required by either your insurance provider, a retailer, or both. If you are looking into getting a custom-made piece of medical equipment, you will need to talk to your doctor and insurance company at length to make sure you get the right equipment and that equipment is covered by your insurance.
Does Medicare Pay for Home Medical Equipment?
Yes, but the process can be even more complex than billing with other insurance providers. For more information on Medicare and medical equipment billing, read our comprehensive blog.
What are the Advantages of Paying Cash for Medical Equipment?
There are many advantages of paying cash for medical equipment if you have the resources.
- You get to choose the equipment you want. While most insurance providers limit your choices for covered medical equipment, paying cash allows you to choose the product that feels the best for your needs.
- Getting help from a Medical Equipment Professional. While doctors and insurance providers know what type of product a person needs, they usually don’t have information on specific brands and types of a given product. Buying a piece of equipment from a retailer allows you to get information that will help you select the best product for your needs.
- Try before you buy. Medical equipment is not one-size-fits-all. Some insurance plans will only pay for certain products, which may be uncomfortable for individual needs. Trying medical equipment before you buy it allows people to pick the product that feels the best for their needs.
- Service & Repairs. Many medical equipment retailers offer in-house service and repair systems that will get your equipment fixed very quickly. Submitting medical equipment to insurance for repair can take weeks–which is almost impossible for people who rely on a specific piece of equipment to manage without.
- Rentals. Many medical equipment retailers also offer rentals. If short-term rentals are an option you may be able to test a product you are looking into at home before you buy it. Rentals also offer relief while waiting for a repair or can be a great option for travel.
Does Oswald’s Bill Insurance for Medical Equipment?
Oswald’s does not submit insurance or Medicare/Medicaid claims for most products. If you have specific questions on a product or would like to know what forms will help your self-billing claims, don’t hesitate to give us a call or send us an email. We’re open 7 days a week!
