After talking with newly injured clients and caregivers last Friday at the Abilities Expo in Minneapolis, I found a common theme arise. How do I get this item (stander, wheelchair, cushion, etc.) purchased for me? I was amazed at how many people recently (and not so recently) out of rehab had not been explained the procurement of Durable Medical Equipment (DME). I’m not sure if it’s because they had more important life issues on their minds when in rehab, and were inundated with information? Of if we, the DME team (manufacturers, suppliers, and clinicians) are trying to make the process invisible so as not to overburden the consumer during a difficult time of adjustment?
I’m guessing it’s a bit of both. Regardless, somewhere before leaving rehab there should be someone or some document that explains what DME is and the normal process for acquiring these life-necessary technologies.
There are many different payers who have different needs for funding DME, but generally speaking the ideal process is as follows:
- Discuss with your physician the specific need you want to address with the item of DME. Ask for a referral to a clinician or OT/PT that can help with the evaluation process.
- Pull together your DME Team (therapist, local DME supplier, caregivers, & self).
- Set up time for evaluation /trial of the equipment or technology you think will work best for you.
- The therapist will document the outcomes from this trial and write a Letter of Medical Justification or Necessity (LMN).
- Once the LMN is signed by the medical team, therapist, and physician, it is sent to the DME Supplier for prior authorization with your funding source.
- When approved by your funding source, the DME will be ordered, received, assembled, delivered and fit by the supplier.
- If your funding source denies or pends your DME prior authorization, review your right to appeal in your benefits book from your funding source. Then decide your next step. Remember there are many on your team who are willing to help with this process, but you, the consumer hold the most weight in an appeal.
This is just a brief outline of the process. Many more funding tips as well as legal resources for appeals are available on our website.
Why do you think consumers are not more educated on how to get the DME equipment that they need? Have you had any experiences getting DME that you would like to share with others? Am I missing any important steps of the DME equipment purchasing process?
