What is Durable Medical Equipment?
Durable medical equipment (DME) are items that benefit a patient and assist in alleviating issues related to medical conditions, disabilities or illness. DME is reusable, reliable and appropriate for short or long-term use in the home. It serves as an affordable option for caregivers seeking equipment to enhance the lives of those they care for. In many cases, DME is vitally important to the health, safety, healing, and increased independence of a patient. DME is not necessarily designed to meet the needs of individual medical conditions, but there are certain machines and tools that are designed specifically for an illness or disability.
DME includes a wide range of items including but not limited to:
- Canes
- Crutches
- Hospital beds, pressure mattresses, lifts, lift beds
- Personal care aids (i.e. bath and shower chairs)
- Portable oxygen equipment
- Prostheses (artificial limbs)
- Scooters
- Supportive braces
- Walkers
- Wheelchairs
Medical Prescription for Medical Equipment
A physician, nurse, or hospital discharge planner may prescribe a patient durable medical equipment. After a medical visit or hospital stay, a patient may receive a prescription for DME. Medical devices not deemed medically necessary may not qualify as durable medical equipment. For example, smaller items, such as railings to aid in the transition out of a shower or bath, might increase the quality of life for an aging patient far more than what meets a doctor’s eye at an annual check-up. The type of DME ordered will largely depend on an individual’s abilities and conditions with or without the assistance of a caregiver.
Does Your Insurance Cover DME?
Prescribed medical equipment is not always covered by insurance. Many times the patient’s type of insurance dictates the medical procedures and specialty visits to see a doctor. A private insurance plan may be more likely to cover the costs of an electric wheelchair or scooter, whereas a state Medicaid plan may not. In the U.S., where insurance companies can determine their own coverage policies, coverage of DME can vary substantially from one insurer to the next. Unfortunately, healthcare disparities are often amplified in this system. A parent in a low-income household may pay less money per month for their health insurance but may also belong to a Medicaid plan whose policies do not reimburse for DME. The answer to the commonly asked question of ‘who pays for DME?’ will depend on one’s insurer.
Medical equipment must meet certain criteria to qualify for DME insurance coverage. Durable medical equipment that provides a therapeutic benefit has an increased chance of coverage. Contact your insurer to verify your coverage. Durable medical equipment must address a medical need and not just for convenience.
The durable medical equipment you are searching for may not always be readily available. If you are borrowing DME from a medical loan closet, you may have to add your name to a wait list. If you are purchasing DME, you may have to place an order from your local medical supplier or buy online.
Borrow or Buy DME: Do Your Research
A Medical Loan Closet offers individuals with a disability the opportunity to borrow, free or at low cost, durable medical equipment. Most medical loan closets operate as a charity. Depending on its size, a loan closet may be limited in their equipment inventory and hours of operation.
A standard online search may be the best place to start, as there are multiple DME vendors across the nation. Research the medical loan closet or seller to ensure it is legitimate. Visiting credible, well-known lending closets or retailers in the area is a great way to meet the program staff, ask questions about the equipment, and see the items firsthand before borrowing or purchasing. At this time, you should ask about out-of-pocket costs and/or required coverage related to borrowing or purchasing the pre-owned medical equipment.
Insurers may have restrictions on the type or brand of DME they prefer to cover. This can pose a problem for patients transitioning from hospital equipment to home equipment. The patient has grown accustomed to the hospital equipment and may prefer to purchase the same DME for home use. However, patients may not always have that option for various reasons. Yet, borrowing from a loan closet program may be a less restrictive process than buying new equipment using your insurance.
Modifications to Meet Your Needs
Once the equipment is purchased, delivered, and in use, it may require modifications based on the patient’s needs. For example, the mobility of an oxygen tank may need to be adjusted based on the mobility of the patient, or the turning radius of an electric scooter may require adjustments due to the size of a patient’s home. Finding comfortable, well-suited, and well-adjusted DME may be a long process, but the time is ultimately worth it due to the role and duration of a patient’s life that these items are used for.
Equipment Maintenance
Maintenance and hygiene of DME are also imperative. Although an insurer might provide the equipment, the ongoing use of such items will require a person to maintain, upgrade and clean it. You may need to change the sheets on a hospital-grade bed or replace padding on crutches. Consider the maintenance or replacement of the DME you choose.
DME endures Long-Term Use
There is often confusion around durable medical equipment and other medical supplies. The utility of DME is long-term as opposed to non-DME items which are disposable, one-time-only use medical supplies. Disposable medical supplies may include gloves, blood testing strips for diabetics, insulin needles, catheters, and other incontinence products. Disposable items do not qualify as durable medical equipment. Insurance coverage like Medicare usually does not generally cover disposable medical equipment or supplies, under DME coverage.
Caregivers or loved ones assisting their patients or family members with DME in the home or nurses and physical therapists utilizing DME in rehabilitation centers and hospitals must be acutely aware of their patients’ DME. Pay close attention to the process of borrowing or buying durable medical equipment. Carefully review your DME medical prescription and know your out-of-pocket costs. Your caregiver or medical professional can help you handle such details on your own. Misinformation or mishandling of DME can pose a health and safety risk.