As an orthotic and prosthetic provider, the main focus is obviously care related to a brace or prosthetic limb.  In addition to a brace or prosthetic device, however, there is often a need for peripheral equipment. 

The relationship between a lifetime brace or prosthetic user and the orthotic and prosthetic facility is crucial and intimate.  Appointments are required on an ongoing basis, throughout the user’s lifetime, and so many orthotic and prosthetic facility staff members will be asked about other durable medical equipment (DME).  It’s very common for a new amputee to ask a prosthetist, “How do I get a wheelchair lift?”

Orthotic and prosthetic facilities may have a wealth of information related to orthotic and prosthetic care, but the details on durable medical equipment (DME) can be foggy.  To truly support someone living with an amputation, it would be wise for that orthotic and prosthetic facility to understand care related to other durable medical equipment (DME), not just orthotics and prosthetics.

To clarify some of these durable medical equipment (DME) coverage issues, and to dispel some of the myths, we interviewed Allison Weber, with A-Ability in Tampa, Florida.  A-Ability is one of the many durable medical equipment supply companies that cater to amputees and others with limb deficiencies.

Q:  A-Ability carries a variety of medical equipment.  When people think of medical equipment, they usually think of crutches or walkers.  Are people ever surprised by the equipment you carry?  What type of equipment do you think people just don’t realize is available? 

A:  People generally don’t realize the type of equipment available on the market, much less what we carry… until they or a family member actually needs it.  It is then that they are amazed at the technology and then they’re shocked at the price.  Because our company specializes in high-end rehabilitative custom equipment, the equipment is much higher in quality than out-of-the-box durable medical equipment (DME).  People don’t realize the amount of labor that goes into this type of equipment, before and after they actually order it.  Unfortunately, the labor is included in the allowable/price of the wheelchairs.  Therefore, the $25,000 power wheelchair is not pure profit.

Q:  Once a prosthetic or orthotic user receives a prosthesis or brace, there can be additional equipment required.  In your experience, do physicians or case managers acknowledge this and request this additional equipment?  If not, how do you think the consumers find out about this additional equipment? 

A:  I believe that a lot of consumers gather information online, or from other individuals in support groups.

Q:  People living with amputations often have a lot of questions about wheelchair lifts and car modifications.  Does insurance cover this?  How would a person go about obtaining something like this?

A:  The only two insurance entities that cover vehicle modifications are TriCare and worker’s compensation insurance.  Traditional group health insurance and federal or state health coverage (such as Medicare and Medicaid) do not.  Other options for funding for vehicle modifications is perhaps Vocational Rehabilitation, if the individual is able to still work or go to school/training.  Also, the Veterans Administration also helps with funding for veterans.  Some support groups also provide funding.  Most of the vehicle manufacturers offer a rebate on new cars for modifications.  However, the rebate is limited to $1,000.00.

Q:  Are ‘used’ durable medical equipment (DME) items available for purchase? 

A:  We carry some ‘used’ equipment, such as exterior vehicle platform lifts, manual wheelchairs, a few power wheelchairs, and scooters.

Q:  What are the 5 common myths about your durable medical equipment (DME) industry, in your experience?

A:  Here are 5 myths that we hear on a regular basis within the industry, not necessarily about the industry: 1. Durable medical equipment (DME) companies are rolling in money.  2. Medicare will purchase you a new wheelchair every 5 years, automatically.  3. All you need is a prescription for a new wheelchair to be funded by Medicare, Medicaid, or insurance.  4. The physician knows how to prescribe a wheelchair.  5. An authorization from your insurance is a guarantee of payment.  This is not always the case because the insurance companies can always change their mind once they receive the actual claim.

Q:  If you could give a few points of advice for your costumers, what would it be? 

A:  Price should not be the only factor in deciding which piece of durable medical equipment (DME) equipment to purchase.  You should make sure that the durable medical equipment (DME) company is well established, has credentialed and factory-trained staff, actually has a store (not just a mobile service truck), and is in your insurance network.  Establish a relationship with a case manager at your insurance company to assist you with the pre-approval process.  Verify that each item that you want the insurance company to fund is actually covered by your policy. 

Q:  There is a lot of information on the internet, as far as wheelchair lifts and similar equipment.  What are the major precautions people should take before believing the online information they read? 

A:  The main thing that people need to realize before they purchase durable medical equipment (DME) via the internet is that the internet provider is not going to come to your home to repair the equipment when it needs service.  The internet company may have a contract with someone to provide mobile service on their behalf, but you don’t know what kind of training that person has received, if any.  Many local companies will not even touch your equipment if you purchased durable medical equipment (DME) via the internet.  A lot of times the internet company that you purchased from may not be available 6 months from now.  One may find the best pricing on the internet because they have very little overhead, but in exchange they have little service after the sale.

Q:  Any final thoughts?

A:  The people that need our services need to research what they are purchasing and where they are purchasing from, just like vehicles or deciding on a physician.  Some people are limited by their insurance networks.  However, if the client stands firmly against their insurance companies, they can usually appeal an initial decision with some viable reasoning and obtain an authorization to go outside of network, or to get funding for an item that is not otherwise covered.  However, ALWAYS, ALWAYS, ALWAYS get it in writing.  If it’s not documented, it didn’t really happen.

For more information on durable medical equipment (DME) services, contact Allison Weber with A-Ability at (813) 620-4475.