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How to Get "Durable Medical Equipment" |
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In a recent issue of the
Pennsylvania Parents and Caregivers Resource Network newsletter, a question
was asked about getting a power/motorized wheelchair from a private insurer.
The following advice was given: 1. Obtain the master health insurance policy from your insurer. 2. Examine the insurance policy carefully to determine how medical necessity and durable medical equipment are defined. 3. Provide a copy of the insurance policy and the definitions of medical necessity and durable medical equipment to your treating doctor. 4. Obtain a narrative report from your treating doctor that indicates the motorized wheelchair is medically necessary, meets the definition of durable medical equipment, and the specific reasons why this type of equipment is needed in your case. 5. Submit this report to your insurance company and request payment for the motorized wheelchair. If you receive a denial, file an appeal. Your health insurance company will provide you a list of your appellate rights. 6. It is very important that you follow all of the time limits set forth in your health insurance policy regarding appeals. It is helpful to request that your appeal hearing be in person, although many of the appeals are done over the telephone. |
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