How to get home medical equipment covered by your insurance
Most health plans cover durable medical equipment when it is medically necessary and ordered by a physician. A few steps up front make the difference between a smooth delivery and weeks of back-and-forth.
1. Start with a written physician order
Your physician or another qualified prescriber needs to write an order that names the equipment, the quantity and why you need it. For many items, your plan will also want recent notes from your physician that describe your condition.
2. Confirm the supplier is in your plan’s network
Using an in-network supplier usually means lower out-of-pocket costs. Ask the supplier to check your plan before anything is ordered.
3. Expect prior authorization for some items
Power wheelchairs, some hospital beds, CPAP devices and other higher-cost items often need approval from your plan before delivery. Your supplier submits the request with your physician’s documentation. Approval can take several days.
4. Ask what you will owe
Coverage rarely means zero cost. Ask for your copay, deductible and coinsurance in writing before delivery, and whether the item will be rented monthly or purchased.
5. If coverage is denied
- Ask your supplier for the denial reason in writing.
- Check whether missing documentation caused the denial. Many denials are fixed by sending the right records.
- Ask your physician to support an appeal if the equipment is medically necessary.
- Follow your plan’s appeal deadlines, which are listed on the denial notice.
Vybes MedSolutions verifies benefits and handles prior authorization for every order. Contact us with your plan details and we will tell you what to expect.
This article is general information, not medical advice. Talk with your physician about your situation.