Durable Medical Equipment, or DME, as it is referred to by insurance companies, Medicare, and Medicaid (known as third-party payers) and suppliers, is medical equipment such as ventilators, braces, walkers, crutches, wheelchairs, scooters, etc., that has a fairly long lifespan and is needed to support, protect, and/or enhance function and independence. The equipment that polio survivors remember from early childhood or young adulthood has been replaced with DME that is lighter in weight, more portable, easier to operate, and technologically more advanced.
Reimbursement made by insurance carriers for purchase of DME varies greatly within plans (see Insurance, Health). Many of the products or devices will require a prescription from a physician in order to bill an insurance carrier. Sometimes prior authorization is required. Medicare will pay 80% of the cost it considers reasonable for basic items. Medicare sometimes requires the signature of a specialist or additional documentation to justify some designated equipment, such as a motorized chair or a ventilator.
Obtaining DME requires a step-wise approach to obtain best outcomes. First, identify the problems or areas of decreasing function. Second, seek a professional evaluation of the problems and request suggestions and recommendations for dealing with them, including the use of DME. Third, research the available insurance benefits and follow the plans’ procedures for finding the appropriate vendor, completing forms, etc., to optimize reimbursement.
Some items that generally are not covered by most insurances (though may be covered by long-term care insurance policies) include: chair lifts for stairs, ramps to get in/out of home, adaptations to vehicles to transport scooters/wheelchairs, lift chairs (to lift a person from sitting to nearly upright), adaptations in bathrooms, and motorized mobility equipment (scooters/power wheelchairs) unless needed to get around within one’s home. Depending on one’s location and circumstances, there may be some financial resources available–see the resources listed in PHI’s Post-Polio Directory.