Getting started with home medical equipment

Start with what changed

Almost every DME order starts with an event: a surgery, a fall, a new diagnosis, a hospital discharge, or a slow decline that finally crossed a line. Knowing which one applies to you matters, because it decides what documentation exists and how quickly things can move.

If you are being discharged, the hospital's discharge planner can start this for you and should. If you are at home and things have got harder, it starts with your own doctor.

The five things that have to line up

1. A need that the equipment addresses.
2. A prescriber willing to write an order for it.
3. Documentation in your medical record that explains why you need it — not just that you want it.
4. Coverage, either from a plan or from your own pocket.
5. A supplier who stocks the right item and will do the paperwork.

Four of those five are outside a supplier's control, which is why a good supplier spends most of its effort helping the other four happen.

Where it goes wrong

• The chart note does not say the right thing. The most common failure by a distance. Your doctor knows why you need it; the note has to say so, in terms the plan recognizes.
• Same or similar. You already have something on file that does a similar job, and the plan will not pay again within its replacement period.
• Prior authorization discovered late. Some items need approval before supply, and finding out on day ten wastes ten days.
• Nobody measured. Wheelchairs, compression, braces and beds all fail if the sizing is guessed.
• The face-to-face is missing. Several categories require a documented in-person encounter within a defined window before the order.

What to have ready when you call us

• Your insurance card, or at least the plan name and member number.
• The name and phone number of the prescriber.
• What you were told you need, as specifically as you were told it.
• If it is a supply you already use: the box. The manufacturer reference number on it removes all ambiguity about size and type.
• Whether anyone will be home for a delivery, and whether there are stairs.

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