Types of Insurances
Insurance Resources
Assistance Resources

Durable Medical Equipment & Respiratory Therapy

While there are no licensing requirements for home medical equipment providers, most third-party payers require providers to have JCAHO accreditation.

Providers of in-home services submit claims to insurance companies first. They will send you statements about the billings. Contact your insurance provider for specific coverage information, including criteria, deductibles, and copays.
Be sure to tell your medical equipment provider if you have insurance or if you change your insurance.

Highly customized wheelchairs and rehabilitation equipment are specialty categories available from selected providers and are reimbursed based upon individually negotiated rates by most providers. Prior authorization from the patient's insurance carrier is required for customized items, although reimbursement is not guaranteed.

Secondary Insurances, including Medical Assistance, may affect the claim and reimbursement.

Bathroom equipment and disposable supplies may not be covered by insurance. Sometimes Long-term Care Insurance, Pennsylvania Medical Assistance or Pennsylvania Medical Assistance Health Choices may provide coverage. View Assistance Resources and Insurance Resources for more information.

Commercial Insurance
Commercial Insurance may provide coverage. Check with your insurance representative about durable medical equipment and respiratory therapy coverage.

Medicare
Medicare pays for durable medical equipment in different ways, depending on the item or service (service includes service calls for repair and routine maintenance) and whether you buy or rent the equipment. Medicare may pay for specialized equipment — such as highly customized wheelchairs and rehabilitation equipment — based upon the pre-established fee schedule.

Medicare pays the same amount whether the supplier agrees to accept the Medicare-approved amount as payment in full or not.

Not all suppliers will agree to accept the Medicare-approved amount as payment in full. If you buy equipment from a supplier who does not agree to accept the Medicare-approved amount as payment in full, Medicare will pay only 80 percent of the Medicare-approved amount. You are responsible for the difference between what Medicare pays and what the supplier charges.

If the supplier agrees to accept the Medicare-approved amount as payment in full, and if you have already met your deductible for the year, Medicare pays 80 percent of the Medicare approved charge and you're responsible for the remaining 20 percent.

You may pay more if the supplier does not agree to accept the Medicare-approved amount as payment in full.

Auto Insurance
Auto Insurance may provide coverage. Contact your auto insurance representative to review coverage and reimbursement.

Managed Care Insurance
Managed Care Insurance companies identify their "network" health systems. Contact your insurance representative to discuss reimbursement for durable medical equipment and respiratory therapy.

Workmen's Compensation
Workmen's Compensation may provide coverage. Contact your representative to discuss coverage.

U.S. Veteran's Benefits
U.S. Veteran's Benefits may have coverage for durable medical equipment and respiratory therapy. Contact a U.S. Veteran's Benefits representative to discuss reimbursement and providers.

Medical Assistance
Medical Assistance has coverage for durable medical equipment if prescribed by a doctor and approved by the Department of Public Welfare.

Long-term Care Insurance
Long-term Care Insurance policies may provide coverage. Check your policy or call your insurance representative to find out if the product is covered.