Referrals:  What equipment is covered?

Nearly all of our equipment is covered by insurance with a few exceptions. Some of these exceptions have to do with specific diagnosis restrictions (i.e. oxygen therapy orders with a diagnosis of pleural effusion are only covered when written from a medical office due to most insurance requirement that the patient be in a “chronic-stable state, with no underlying conditions”), other restrictions have to do with insurance company’s determination of “Medical Necessity”. 

A good thing to remember when writing an order that will be covered by your patient’s insurance is: “is there a cheaper option that has a similar therapeutic effect” if yes, that will likely be the option that is covered by the patient’s insurance. 

Here’s a short list of common items that are usually NOT COVERED by any insurance: 

• Bathroom items including: Toilet Seat Risers, Bath or Shower Chairs, Grab Bars, Walk-in Tubs
• TV Trays 
• Lift Chairs (except the lift mechanism, usually about ⅓ of total cost) 
• Knee Scooters (aka Knee Walkers) except by certain insurances
• Certain Braces
• CPAP Cleaners (Devices and Wipes)
• Travel CPAP Machines

Or any equipment ordered without a qualifying diagnosis or lacking necessary paperwork.

Apart from this, coverage is always determined by benefits outlined in the patient’s plan and any deductibles or copays required by the insurer. 

Navigating the complex world of insurance coverage can be frustrating and complex. The good news is, Mayhugh’s is here to help. Send us the order and our billing experts will determine if the item is covered and if any supplementary documentation is needed.