What durable medical equipment (wheelchair, bath bench, walker, etc) is covered?
Medical equipment is usually a covered benefit, if it is medically necessary. The Evidence of Coverage should be reviewed to determine the criteria and definitions which are used to define medical necessity for these benefits. For Medicare and Medicaid beneficiaries, these benefits may be interpreted very strictly. Employers will sometimes put specific limits on the number and types of medical equipment that are covered under the health plan; employees may be unaware of these restrictions. Another area of confusion for individuals is that the health plan will often approve certain types of equipment for a given time period. The types of equipment may be changed, depending upon medical necessity. However, individuals sometimes interpret the prior authorization for specific equipment to be the only equipment allowed. Additional equipment may be approved subject to change in the individual’s condition. It is important to also note that the health plan has a contract with specific agencies
