Hello there, dear reader! Ever found yourself stuck, trying to figure out how to get approved for a hospital bed, or maybe some other DME, also known as Durable Medical Equipment? If so, I’ve got you covered!
I know, I know, it sounds daunting, doesn’t it? But trust me, once you get the hang of it, you’ll be navigating this process like a pro. So grab a cup of coffee, and let’s dive right in!
Here is a bulleted list to help you get this done quickly:
For Medicare-covered hospital beds, the following requirements must be met:
– A qualifying diagnosis is necessary.
– The patient must either need:
– The head of the bed (HOB) elevated 30 degrees or higher due to respiratory or aspiration issues.
– Frequent position changes due to severe pain issues.
– It must be clearly stated that pillows or wedges have been tried but are not effective, along with reasons for their inefficacy.
Private insurance requirements:
– These requirements may not be as strict.
– Private insurance may cover fully electric beds if offered by the provider though not all providers offer this.
– If the patient meets the Medicare requirements and maintains good chart notes, along with a Letter of Medical Necessity (LMN):
- The LMN must be signed and submitted to the DME company by your physician.
- In order to find a durable medical equipment provider near you, type into google “durable medical equipment supplier near me.” This should populate the nearest locations. I would recommend calling them and asking if they are able to order the type of equipment you are looking for as each business is different.
Here is an example of an LMN:
Please fax to Dr. John Smith
Your patient Mary Jones is in need of a front-wheeled walker. Please complete the following on an order from you to expedite the process. Then fax the order and patient demographics to the pharmacy/DME supplier number below
REQUIRED ON ORDER
Name [insert name]
DOB: [insert date of birth]
Qualifying diagnosis: [Insert qualifying diagnosis]
Height: [insert height] Weight: [insert weight]
Item requested/Equipment: [insert type of DME requested]
Please send to: [insert DME company name here]
Fax- [insert fax #], Phone- [Insert phone #]
Please let me know if I can provide further information.
[Insert your healthcare provider, usually a physical or occupational therapist]
Understanding Durable Medical Equipment (DME)
First things first, let’s chat about what DME actually is. Ever had a flashback to high school biology class and thought, “DME? Isn’t that something to do with cells?” Well, I hate to burst your bubble, but in this context, we’re not talking biology. We’re talking medical equipment—specifically, equipment that’s built to last.
Durable Medical Equipment, or DME, is any equipment that provides therapeutic benefits to a patient due to certain medical conditions or illnesses. This could be anything from wheelchairs and walkers, to hospital beds and nebulizers.
Figuring Out If You’re Eligible
Alright, now that we’re clear on what DME is, the big question is, how do you know if you’re eligible for it?
Well, typically, to qualify for DME, your doctor has to confirm that the equipment is medically necessary for you. This means it has to be used for a medical reason, be appropriate for use in your home, and be likely to last for at least three years.
Now, you might be thinking, “Great, but how do I know if my need for a hospital bed at home qualifies?” Good question, my friend! To answer it, let’s move on to point 3.
Qualifying for a Hospital Bed
Getting approved for a hospital bed at home isn’t as simple as saying, “Doc, my bed isn’t cutting it anymore.” There’s a little more to it.
First off, your doctor needs to document why you need the bed in your medical record. Then, they must write and sign a prescription, stating that due to your medical condition, you need a hospital bed in your home.
And you know what’s the key here? Medical necessity. The bed must be needed for positioning, to prevent or treat pressure ulcers, or if you need the bed for special care, like frequent changes in body position or other medical conditions.
The Approval Process
Okay, now that we’ve figured out the why, let’s chat about the how. Once your doctor has confirmed the medical need, the next step is the approval process.
If you have insurance, including Medicare or Medicaid, they typically cover DMEs, including hospital beds. However, they require you to obtain the equipment from a supplier within their network.
And it’s not just a matter of asking nicely. Your doctor will need to submit a Certificate/Letter of Medical Necessity (LMN/CMN) to your insurance provider.
And don’t worry, if you’re feeling a little lost at this point, remember, your doctor’s office and your medical equipment supplier are there to help. They’ve gone through this process many times and can guide you through the necessary steps. Make sure to follow up several times per week to make sure this goes through!
Doctors’ offices get busy and it’s easy for things to fall through the cracks!
What If I Get Denied?
Alright, we’ve made it this far. But what happens if you get denied? Well, don’t panic! It’s not the end of the world, I promise.
If your application is denied, you have the right to appeal. Each insurance provider has a different appeals process, so you must check with them for the specific steps. But remember, persistence is key!
Phew! We’ve covered quite a bit of ground, haven’t we? From understanding DME to navigating the approval process, you’re now armed with the knowledge to conquer the daunting world of DME approvals. But most importantly, remember that you’re not alone. Resources are available, and people are ready to help, every step of the way.
And as always, if you’ve got any questions, feel free to drop them in the comments below or send me an email. Here’s to taking control of your health and making informed choices. Until next time, stay well!