How to Get Medical Equipment Covered Through Insurance

Robin Mead

Medical equipment can include:  Shower chairs, electric wheel chairs, walkers, canes, mobility scooters, manual wheelchairs, hospital beds, TENS machines for pain, oxygen machines, compression stockings, and many other things. Here’s some tips for getting things covered:

Getting an Assessment

If you would like your equipment to be covered by insurance, you will usually need:

💜 An assessment of your need for equipment from your doctor or a physical or occupational therapist. For small pieces of equipment, some insurance companies do not require an assessment and will accept a simple doctor’s prescription. Learn more: How to Get an Assessment

💜  A medical supply company that accepts your insurance. Be careful. Just because a medical supply company tells you that your insurance will reimburse you, that does not make it true! How to Find a Medical Supply Company

Sample Policies

If you wish to get your equipment covered, the best thing to do is LEARN THE RULES. See how that is in all caps? It is very difficult to qualify for medical equipment (or for any other service or program in this world) if you don’t know the rules. Here’s a few examples:

💜 Policy for walkers, canes and crutches from Aetna.

💜 Aetna’s policy for compression stockings.

💜 More aetna policies for many different kinds of equipment.

💜 Policies for Medicare for many different kinds of equipment.

💜 Medicare policies for Hospital Bed

💜 General policies for Electric Wheelchair or Scooter

Finding the Rules for Your Insurance Policy

💜 Insurance companies rules are sometimes very similar and sometimes exactly the same for different companies. If you are unable to find the policies for your company, reading the policies above may be good enough.

💜 Don’t rely on your doctor to know the policies for your insurance company. You are likely to be disappointed.

💜 You can try researching online to see if your insurance company includes their policies online. Look for “durable medical equipment.”

💜 If you get assessed through a rehabilitation program or center, the practitioners there will often know the insurance company policies. You can also look for physical or occupational therapists who specialize in medical equipment assessments (sometimes called “seating specialists”)

💜 One reader reports that she has had a lot of success getting information on how to qualify for things by contacting her insurance company and asking to speak directly to the nurse or other person in charge of screening and approvals for medical requests.

💜 The medical supply company you use can also be a good resource. They may have someone on staff who knows your insurance companies policies. In some cases, they will send the policies to your doctor for you.

💜 Here’s some advice from Wheelchair.net: Larger medical supply dealerships hire a “reimbursement specialist” or “insurance specialist.” Make use of this person to help you. This is a person who is familiar with insurance company policies and procedures. They can ask the right questions of claims adjusters at your insurance company. The procedural knowledge of a funding specialist can be very helpful to both individuals who need wheelchairs and to the professionals who want to see their patients get a good match with the right wheelchair.”

💜  Hint: If you have questions about getting insurance approved, when you call the medical supply company, do not talk to the person who answers the phone. Ask to speak to someone who specializes in insurance approvals.

Special Rules for Mobility Equipment

💜 If you are applying for mobility equipment (cane, walker, wheelchair, etc), some insurance companies will want to know if you need it for use inside your home. You are allowed to use it outdoors as well, if you want.

💜 They will also need to know if it is helping you with activities of daily living (eating, dressing, bathing, bathroom).

💜 If you only need the equipment for outdoor use (shopping, walking outside, going places) for most insurance companies, you will be denied. There is no point in appealing, because you will just keep being denied. Sorry, those are the rules.

💜 This is generally always true for large-ticket items like electric wheelchairs or mobility scooters. For smaller items, like canes or transfer chairs, some insurance companies will accept a simple doctors prescription without requiring more detail.

If You Are Applying for Disability or on Disability

🍃 If you are applying for Social Security, it is much better to get your medical equipment through a doctor then to just buy it yourself. If you go through a doctor, this will create documentation that can help your case.

🍃 Please take a look at How to Document Medical Equipment While Applying for Disability

If You Get Denied

🍃 If your medical equipment is denied by your insurance and you would like to appeal, your state’s protection and advocacy program may be able to assist.

🍃 You could also try reading the link above about applying through insurance, and then applying again now that you and your doctor are more educated about the policies.

🍃 You can also give up on insurance and try some of the resources listed above for programs that don’t require insurance.

🍃 How to Pay for Medical Equipment Without Insurance

---

Learn More

Learn more about kinds of medical equipment, how to qualify for equipment, and how to document equipment for disability: How to Get Medical Equipment