How to understand your medical equipment insurance coverage
Updated On: Jul 05 2013 11:55:33 PM EDT
Health insurance companies can be frustrating, confusing and sometimes downright unfair.
Especially if you or your parents are aging or disabled, and need a piece of durable medical equipment. That's a piece of equipment that can range from a cane to a power chair to a hospital bed.
For Arnold and Elaine Hurwitz, losing his wheelchair was devastating.
"We couldn't take him to the doctor, we couldn't take him anyplace, he was home bound," said Elaine.
It was all because of something so simple, it could happen to anyone; a paperwork mix-up. Arnold's toe was amputated about a year ago because of poor circulation.
Medicare sent him a wheelchair, but the Hurwitz' decided they didn't need it, so they sent it back.
However, Medicare will only pay for a new wheelchair every five years, because the equipment is durable, and therefore supposed to last a designated amount of time; wheelchairs generally last about five years.
But now when Arnold needed one after both legs were amputated at about the knee, they found Medicare had no record the prior wheelchair had been returned.
"It was just a mess," said Elaine.
The bills kept piling up, with no money left to get a new wheelchair.
But Arnold's physical therapist told them about Stepping Stone Medical Equipment Bank.
"We pick up and refurbish medical equipment and distribute to either seniors or disabled adults in the Central Florida area," said Wayne Gardner, Senior Director of Stepping Stone, an organization under Seniors First, Inc.
"We said, 'Boy, this would be great' and 'I thought to myself, what is this going to cost? and how am I going to pay it?'," said Elaine.
But they didn't need to worry. Stepping Stone offers low or no cost medical equipment and they weren't going to have to pay a dime.
"Wayne found out that he was a veteran and he said, 'If you're a veteran, we're giving it to you'," Elaine said.
"When Elaine came over and told me, 'We don't have to pay, just the battery', I said, 'What are you, crazy?'," Arnold said. "I mean, who does that nowadays? But Stepping Stone did."
But the reality is, for most people, it's not that easy.
To get a prescription for a piece of medical equipment, you need to see your doctor-face-to-face; and you could have as little as 30 days to send that prescription in to your medical supply company.
That prescription, and supporting documentation from your physician, needs to say the equipment is "medically necessary," not just that it would be helpful or convenient.
For example, if you require a wheelchair, but still have the use of your arms, most insurances will only approve a traditional wheelchair. Even though a motorized, or power, chair may give you better quality of life or could really help you in your day-to-day tasks, if it isn't medically necessary, it often won't be approved.
Even if you are covered, you could still get stuck with huge costs out of pocket.
Insurance companies usually only cover 80 percent of the cost of the item, meaning you'll be stuck with the other 20 percent. That's often after your deductible.
It's also possible the medical supplier you use could want the money you're responsible up front. Even worse, some insurance companies require you to pay the full cost up front, to be reimbursed later.
The problem is, not many people, especially seniors, have that kind of cash on hand.
"The majority of people don't have $10, much less $1200 to $1,300," said Gardner.
He says that's why Stepping Stone does what it does.
"To have people have been told, 'No, you can't,' and they leave here saying, 'Yes, we could, and we did," Gardner said.
Elaine and Arnold said they don't know where they would be, were it not for the kindess of the organization.
"He can get up and go to the bathroom, he can go outside and get fresh air, we can take him for walks around the neighborhood," Elaine said. "What else can I say? God was good to us, he led us there."
Stepping Stone works largely off donations from the community. In fact, Elaine and Arnold were actually able to donate equipment Arnold no longer uses, like canes and walkers, back to the organization.
They have a certified technician on staff that cleans and refurbishes all the items, which is why Gardner said they're able to keep their prices so low.
If you would like to make a donation or would like to inquire about Stepping Stone's services, click here.