This article was last updated on Nov. 24, 2020.
If you're dealing with a health condition or recovering from surgery that requires durable medical equipment (DME) Glossary popover, you may find yourself wondering where to get medical equipment and if insurance covers it. DME is typically used to help you do things that you might be unable to do because of medical circumstances. It might be something you use temporarily or for a lifelong condition.
The good news is, your health insurance typically covers durable medical equipment.
Some of the most common types of DME are:
- Breast pumps
- Oxygen equipment
- Insulin pumps
But, getting medical equipment and making sure it's covered according to your health insurance coverage isn't quite as simple as showing up at the store and making the purchase.
That's why it's important to follow these 4 steps.
Get a prescription from your doctor
Just like you need a prescription for medication, durable medical equipment also requires a prescription to be covered by your health insurance. It's essential to applying your health insurance coverage to DME. Talk to your doctor about what you might need, based on your condition. If you're pregnant and need a breast pump, for example, consider getting the prescription from your doctor a few weeks ahead of your due date, so you have the script in-hand at the hospital on delivery day.
Check your health insurance benefits
Your health insurance company's customer service can make sure your coverage applies to the durable medical equipment you need, verify what brands are covered, and help you understand your cost share. Whether it's a copay (a fixed amount you may have to pay out-of-pocket when incurring medical expenses), coinsurance (a portion of incurred medical expenses, usually a fixed percentage that you must pay out of pocket), or deductible amount (what you owe for covered health care services before your health insurance plan begins to pay), we'll help you understand the portion of the cost you'll be responsible for.If you're a Wellmark Blue Cross and Blue Shield member, you can also log in to myWellmark® to learn more about your benefits Opens New Window. To see your durable medical equipment coverage, look under “H” in your coverage manual for Home/Durable Medical Equipment. If you're not registered for myWellmark yet, it only takes a minute. Get registered today Opens New Window.
Find an in-network DME provider
It's simple to find a DME provider near you with myWellmark. By logging in, you can be sure you're searching for DME suppliers within your plan's network. There are local DME suppliers and mail order companies, like Better Living Now External Site or Edgepark External Site, so it's easy to find one that works best for you. Using an in-network provider is the simplest way to avoid unexpected costs and make sure you get the most from your benefits.
Contact your in-network durable medical equipment provider to arrange the purchase
At this point, you can work with your provider to determine how much that copay, coinsurance or deductible actually amounts to, and if the equipment will be purchased or provided on a rental basis. All of these details are specific to your benefits, so work with your DME provider and Wellmark Customer Service to make the most of your DME benefits.