insurance

Insurance

Bellevue Healthcare understands that the rules and regulations concerning home medical equipment are constantly changing, which is why we continually strive to stay informed and up to date on industry changes and regulations so that we can help our patient’s navigate the insurance labyrinth.

Bellevue Healthcare is contracted with Medicare, Medicaid and many other insurance providers.

Please note that this is not a complete list. The above list consists of contracted payers. New payers are added as they become available, and many insurance companies will approve services with prior authorization. If you have a question regarding whether or not Bellevue Healthcare accepts your insurance please call customer service and they can answer any questions you may have.

Bellevue Healthcare accepts insurance assignment in most cases; however payment balances that are not covered by insurance are the responsibility of the customer. These balances may include co-insurance, deductibles, or denials. Bellevue Healthcare makes no guarantee of payment and may not always be able to determine payment responsibility prior to issuing equipment. You may be responsible for payment up to retail value should the necessary billing documents or authorizations not be made available to Bellevue Healthcare in a timely manner by you, your physician, or insurance carrier.

Bellevue Healthcare is committed to providing the highest quality medical equipment and supplies, as well as conducting our business with the utmost integrity and honesty. Bellevue Healthcare routinely conducts internal audits to verify correct billing practices and maintain high ethical standards. Bellevue Healthcare has been Joint Commission Accredited since 2002 and maintains the highest level of program compliance in all practices, including billing, equipment delivery and handling, equipment cleaning, and sterilization practices. You can count on Bellevue Healthcare to always maintain the highest standards regarding ethical, legal, and sound business practices.

For more information please visit some of the topics listed below:

How Does Medicare Pay for Home Medical Equipment?

To get Medicare to cover your durable medical equipment (DME),your doctor or home health agency (HHA) must fill out an order or prescription and explain why you need the item (medical necessity).

Once you have the doctor’s order or prescription, you can take it to any Medicare-enrolled supplier. Medicare will pay 80 percent of its approved amount (after you meet your Part B deductible) and you or your supplemental insurance pay the balance.

Medicare will generally only pay for the most basic form of the equipment that you need.

Medicare will pay for only one item or piece of equipment for a particular condition at any one time. For example, if you are generally confined to a wheelchair but can sometimes use a wheeled walker with a seat, Medicare will not pay for both. You should choose to have Medicare cover the piece of equipment that you need most and that you can only afford with Medicare’s help.

If your condition changes and you need a different kind of equipment, Medicare will allow you to make a switch as long as a doctor fills out a new order or prescription, and fills any other requirements for the equipment you need (for example, examines you in person if required by Medicare).

If you are in a Medicare private health plan (like an HMO or PPO), you must follow the plan’s rules for getting DME, which may be different from Medicare’s. These rules often include getting prior authorization for equipment from the plan and going to a doctor and DME supplier in the private plan’s network. Call your plan to find out what you must do to get DME covered.

DME benefits are administered through the DME MAC (Durable Medical Equipment Medicare Administrative Contractor) in your area. If you have any questions about whether or not a piece of equipment will be covered, contact your local DME MAC by calling 800-MEDICARE.

What Does Not Qualify as DME Under the Medicare Benefit?

Medicare does not pay for all medical equipment. An item does not qualify as DME if it:

  • must be thrown away after use (not durable), such as incontinence pads, catheters, surgical face masks and leggings.
    • Medicare may cover some nondurable items as part of your treatment under the home health carebenefit. If you have diabetes, Medicare may also cover some nondurable items under preventive care, such as lancets and test strips.
  • is not appropriate for home use, like paraffin bath units and oscillating beds. These items are generally used under supervision in an institutional setting.
  • is to be used primarily outside of the home. For example, if you can walk on your own for short distances, enough to get around your house, Medicare will not cover a motorized scooter to get around outside.
  • is for “convenience” rather than “medical use.”This includes stairway elevators, grab bars, and bathtub and toilet seats—anything that can technically be used by people who have no medical condition. Also, Medicare will not cover modifications to your home, such as those for improving wheelchair access, like installing ramps or widening doors.
    • There are many products available to help people with physical limitations continue to live independently. While assistive devices and home modifications are generally not covered by Medicare, there are organizations that can point you to low-cost products and services.