What You Need to Know about Durable Medical Equipment
Experts and former patients share their insight.
Most patients recovering from spinal cord injury (SCI) need some type of durable medical equipment (DME) to help aid in recovery and improve their quality of life when they return home.
DME, which includes a broad range of items from walkers, bathroom equipment and catheter supplies to lift devices, manual and power wheelchairs, is often a central part of discharge planning, but it’s not always an easy process, explained David Kreutz, PT, seating clinic coordinator at Shepherd Center.
“Every insurance company is different in terms of what they cover,” he said. “There are also lots of rules that make it challenging for people to get their equipment, especially power wheelchairs.”
For example, Medicare now requires a face-to-face visit with the patient’s physician. Detailed documentation of a patient’s needs along with a 7-element prescription are required by the physician. Medicare will not provide pre-approval for power wheelchairs. This means the supplier takes on the risk by ordering the wheelchair based on the documentation provided and is not reimbursed until after delivery. Other insurance carriers require that equipment is secured through a preferred or contracted supplier.
“It’s important that you work closely with your supplier and physician so that documentation requirements are completed in a timely manner,” Kreutz said. On average, it can take three months to get a power wheelchair.
Kreutz explained the delivery process often depends on:
- the therapist, physician and supplier completing the necessary documentation to submit to the insurance company;
- the funding source’s review of the documentation and determination of necessity, and;
- the manufacturer’s time to build the power wheelchair and ship it to the supplier.
“While patients are at Shepherd Center, they have access to the best of the best,” said Cele Locke, DME coordinator and case manager. “We place a high priority on educating patients and families about the equipment and getting everything in place before patients are discharged, and we make recommendations based on what their insurance company covers. If there is a denial we try hard to help them get their medical equipment.”
She and others share the following tips when it comes to power wheelchairs and other DME:
Know what’s covered and what’s not. Most insurers don’t cover bathroom equipment or backup wheelchairs, for example. Some insurance companies cap DME reimbursement – even setting the limit as low as $500, which Kreutz says may not even cover a proper cushion.
Take care of your equipment. Understand how to operate and service your equipment to help prolong its life. “Once people get their equipment, some may breathe a sigh of relief,” said Tammy King, RN, MSN, chief nurse executive,. “But they need to take responsibility for it; it’s an extension of their body and needs to be treated that way.”
Medicare will only replace a wheelchair every five to seven years, so it’s critical to take care of it. Almost all insurance companies will pay for routine repair of equipment. Wheelchairs come with a warranty period which varies between different manufacturers and features. Something as simple as a loose steel bolt on an aluminum-framed wheelchair can cause irreparable damage if it’s not tightened.
Get added protection. Contact your homeowner’s insurance carrier to find out whether you can itemize your power wheelchair as personal property just like jewelry and other big-ticket items.
John Hardin, who sustained a C-5 complete injury after a fall, wishes he had done so. In summer 2013, Hardin, 44 at the time, was in the backyard with his family. He became overheated, so he decided to move into the shade of umbrellas set up on the other side of the pool to shift his weight. In the process, he had a spasm and fell onto the joystick, accidently turning the wheelchair and plunging into the pool – luckily in the shallow end. His son jumped in and undid his seatbelt, but the water ruined his wheelchair. “Paying $35 for the year to itemize the chair under my personal property insurance would have paid for the replacement,” Hardin said. Instead, he had to find a used chair, but it’s “not near like the one I had.”
Nearly eight months later, Hardin finally received a replacement chair, and had to use loaners and backup chairs in the meantime.
File a police report. If your equipment is stolen or damaged as part of an accident, it’s important to document what happened in a police report.
Be an educated consumer. Stay on top of and ask about new products that may give you more independence than your current equipment. When it comes to wheelchairs, pay attention to two things in particular: First, make sure you can always get your wheels rolling and second, have a back-up cushion even if it’s foam so that you avoid sitting on a flat surface, which can lead to skin breakdown.
Plan for the unexpected. Consider assembling a backpack or box of emergency supplies, including a first aid kit, screwdriver, wrench, any special adaptations if your wheelchair tire goes flat and any other items that could serve as quick fixes for your equipment.
Develop a good relationship with your supplier. If you are a good customer, they may be more likely to let you borrow equipment if the need arises. The supplier or company that sold the wheelchair to you will also likely be the one to repair your wheelchair. Keep their phone number handy, along with the serial number of your power wheelchair if you have one.
Be resourceful and persistent. There are places that offer refurbished DME. In Georgia, Friends of Disabled Adults and Children (fodac.org) and the Brain and Spinal Cord Injury Trust Fund (gatrustfund.org) are valuable resources. Churches and other community resources may also have donated DME.
Shepherd Center, located in Atlanta, Georgia, is a private, not-for-profit hospital specializing in medical treatment, research and rehabilitation for people with spinal cord injury, brain injury, multiple sclerosis, spine and chronic pain, and other neuromuscular conditions. Founded in 1975, Shepherd Center is ranked by U.S. News & World Report among the top 10 rehabilitation hospitals in the nation. In its more than four decades, Shepherd Center has grown from a six-bed rehabilitation unit to a world-renowned, 152-bed hospital that treats more than 900 inpatients, 575 day program patients and more than 7,100 outpatients each year.