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Durable medical equipment questions answered

Do your employees need a prescription?

*This article was last updated April 22, 2020.

Durable medical equipment (DME) expenses rose to a total of $54.4 billion, or 2 percent of all U.S. health care spending External Site in 2017. The need for DME can arise unexpectedly for your employees, and it's normally a time-sensitive purchase. Educating your employees before they need DME will likely save them money — and alleviate any headaches — out of the gate.

DME is a term that many may not be familiar with, even though it’s frequently used to treat or help with medical conditions. And, similar to medications, your employees will need their primary care provider to write them a prescription to purchase covered DME. This quick-start guide will help you and your employees find in-network DME easily.

What is DME?

DME is any equipment to help your employees perform activities they would otherwise find difficult due to medical circumstances. DME may be used by your employee temporarily while they recover from a medical issue, or can be used indefinitely for lifelong conditions.

Some of the more common DME devices include:

  • Insulin pumps
  • Breast pumps
  • Oxygen equipment
  • Wheelchairs

When is DME needed?

The need for DME may arise from a sudden event, such as your employee breaking their ankle and needing a knee walker scooter to be prescribed. In these instances, a medical provider will write a DME prescription at the time of treatment.

In other scenarios, your employees may need DME due to an ongoing medical condition that has worsened with time. In these instances, it’s important the employee first seeks treatment from a health care provider to get a prescription for their DME.

Determining if DME is covered

The first step your employees should take before ordering DME is to get a prescription from their doctor.

Step two? Members can find DME benefits by logging into myWellmark® and viewing the Coverage tab. There, members can find their coverage list and cost information, like copays and coinsurance, to see what DME is covered and how much they may owe.

Tip: members can look under “H” in their coverage list for Home/Durable Medical Equipment. For additional questions, members can call the Customer Service number on the back of their ID cards.

Bonus: Use this ready-to-share article to give your employees a more detailed look at purchasing DME Opens in a new window with BlueSM.

Where your employees can purchase DME

Wellmark Blue Cross and Blue Shield partners with two mail-order DME vendors, Edgepark Medical Supplies External Site and Better Living Now External Site, to make purchasing DME supplies easy. DME supplies can be ordered directly from either of these companies.

Your employees can also search for DME providers by using the Find a Provider tool External Site. Whenever a search is conducted for a DME-related term, the first two search results will direct users to one of the two preferred online vendors, Edgepark or Better Living Now. Results based on location appear below these.

By following the two main rules of DME — getting a prescription and using an in-network DME provider — your employees will save themselves time and money.

Questions? Contact your authorized Wellmark account representative, or email us at Send Email.

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