Durable Medical Equipment

Introduction
Written by Nancy McMahon   

Can I Just Buy It?

One mistake that some people make is purchasing items they believe they need and then filing a claim through Medicare for the durable medical equipment.  This will not be approved in this manner.  Rather, your doctor must specifically prescribe the equipment for you to use.  During this prescription process, they must note that the equipment is necessary for your health. They will need to complete a specific form from Medicare, called the Durable Medical Equipment Necessity Form.  Many doctors will have these forms available to them, but they can also be obtained directly from your local Medicare office.  You will need to submit your claim along with this paperwork directly to Medicare.  Your medical equipment supplier must also submit all paperwork for your claim directly to Medicare to be reimbursed.  Medicare will pay the supplier of the equipment directly for your equipment.

The amount that Medicare will pay is set. They determine what is considered the maximum rate for this equipment, then will pay 80 percent of that approved amount for you.  Payment to the suppliers is done in monthly payments, in most cases.  Anything valued at $150 or less will be paid in full at the time of purchase.  Anything over that is paid in monthly payments, considered a rental payment, for the equipment. These monthly payments will continue throughout the time you need the equipment. Medicare will consider the item paid in full after a period of 15 months, if you continue to need and use the equipment for that length of time.

If you have problems with your equipment over the time that you own it, Medicare will pay for repairs to it, assuming they are considered necessary repairs to keep the item working in good condition. service of equipment is not covered.  Plus, if the cost of repair is more than the equipment is worth, Medicare will not pay for that additional cost.

While most decisions made by Medicare on what is and what is not covered are considered valid, you do have the right to file a claim that you do not believe the decisions were correct.  The process may take some time, but there are several appeal processes to work through. You may want to consider legal help for this process, though it is not considered necessary.  You will have the right to show your case and be heard as to why you believe the costs should be covered.

If you have a need for durable medical equipment, do not purchase it directly.  Rather, talk to your doctor about your medical need and work through your doctor for approval of the item. Suppliers of medical equipment may be able to help you find the right equipment that's covered (as much as possible) through Medicare.  If you believe you may qualify for this coverage, talk to your local Medicare office before making a purchase.

For those who are struggling to make payments on medical equipment, Medicare's plan may be helpful.  If you have insurance through other means, though, you may not qualify for this plan.  Talk to your insurance company directly to find out what type of coverage is available to you through them.  Many people find that the process of filing a claim for durable medical equipment is not as difficult as they believed.  Most suppliers and doctors are well informed about the process and will help you through the process.  You can also work directly with the local Medicare office for more information and guidance.
 
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