According to Medicaid, Durable Medical Equipment (DME) is any equipment that provides benefits to a patient who has certain medical conditions and/or illnesses. DME serves a medical purpose and is not useful to a person without an illness or injury. It is usually ordered or prescribed by a physician. Some examples of DME are:
- Gastrostomy supplies
- Apnea monitors
Families of children who have an ongoing medical condition may need to get DME through their insurance carrier or Medicaid. Each insurance carrier has its own definition of DME, so learning about what is covered under your provider is important.
DME is provided by businesses that specialize in medically-related equipment. In large cities, there are often companies specializing in DME for children.
If you are leaving the hospital, a case manager or social worker will work with you to get the DME your child needs as part of the discharge planning. The case manager may have a list and select a DME provider “by rotation.” However, you do not have to use this provider if you don’t want to. You can work with the case manager or social worker to choose a provider. Just keep in mind that this may be overwhelming, due to the large number of providers in big cities.
Later on, you will probably need to get your primary care physician to authorize your child’s ongoing need so your child will continue to receive the needed equipment. Ask your insurance company to assign you an out-patient case manager to make continued authorizations easier for you.
If you have problems with the company providing the DME, contact the case manager that set up the order and ask for help.
Before agreeing to work with a DME company, find out the answers to these questions:
●Is the DME company “in-network” for your insurance carrier?
●What are your “out-of-pocket expenses"? (This will vary depending on your insurance.) Be sure to understand the details of what you be will be expected to pay.
●How long will it take to deliver the equipment?
●Will someone teach you how to operate the equipment before your child is discharged from the hospital?
●Does the equipment company have pediatric staff experienced in working with both newborn infants and young children?
●What happens if there are equipment problems after regular office hours or on weekends? What is their response time? Will they supply back-up equipment?
●Does the DME company also carry diapers and formula? Can they deliver them with your other supplies?