Durable Medical Equipment
Medicare Part B covers rental or purchase charges for a range of equipment that may be used in a patient’s home. These devices must be deemed medically necessary and prescribed by a doctor. Covered equipment includes hospital beds, patient lifts, crutches, walkers, wheelchairs, scooters, oxygen and traction equipment, various pumps, nebulizers, glucose monitor and dialysis machine. Items not covered include permanently installed wheelchair ramps, stair lifts, handicapped shower stalls, walk-in tubs, grab bars and railings. These items are considered conveniences and not essential equipment.
Applying for Coverage
Even though Medicare regulations indicate that walk-in bathtubs are not covered by Part B, reimbursement can be achieved if the application process is carefully followed. Walk-in tub manufacturers emphasize, however, that because payment is not guaranteed, individuals purchasing this piece of equipment should ensure they have enough money to buy a model. One manufacturer, Rane Bathing Systems, provides its customers with a booklet that outlines what is needed to optimize their chances of reimbursement.
To maximize the chances of reimbursement, applicants should purchase the tub from a company recognized by Medicare. Such companies will have a Medicare provider number and often help customers fill out paperwork. A doctor’s prescription is essential, as it validates need. If Medicare objects because another individual can use the tub, a physician’s letter or treatment plan can explain recommended medical treatment. Medicare Form CMS-1490S must be completed. Rane notes that a statement indicating the supplier did not refuse to file the claim is also needed.
A variety of senior-citizen groups and disabled advocates are lobbying for a change in DME status for walk-in tubs, moving them from designation as a convenience to medical necessity. Successful claims overcome Medicare objections by presenting convincing claims with supporting documentation that outlines unique situations, mobility issues and medical necessity.
When Medicare refuses reimbursement or provides only partial funding, other resources may still be available. These include filing claims with private Medicare supplemental insurance, which covers many expenses that Medicare does not, depending on the policy. Physically challenged individuals who are American veterans may qualify for one of the Veterans Administration home-modification grants that provide funds to those whose injuries were sustained during active duty.