Durable medical equipment (DME) suppliers — how the system works

This article provides general information about the durable medical equipment system. Insurance coverage and specific requirements vary by plan and provider. Your parent's healthcare provider and their insurance company can provide specific information about what's covered and what process to follow.

At some point, you'll probably find yourself trying to work through the system of durable medical equipment. Your parent's doctor prescribes something. A prescription in hand, you realize you don't know who to call, how to get it, whether insurance covers it, or what it's supposed to cost. The system exists but it's opaque. The terminology is specific. The rules are complex. The costs are unclear. You're not alone in feeling lost.

Understanding the system makes the process manageable. You'll know who to contact, what to expect, what questions to ask, and how to solve problems when they come up.

What Counts as Durable Medical Equipment

DME is equipment that's intended for medical use, that can withstand repeated use, and that's primarily for treating a medical condition. The category includes a wide range of items: hospital beds, wheelchairs, walkers, canes, crutches, bathroom safety equipment, lift chairs, mattresses, oxygen equipment, and many other items.

Equipment that's just for comfort doesn't count as DME. A regular bed isn't DME. A regular recliner isn't DME. But a hospital bed is, and a lift chair is. A regular cane isn't DME, but a walker designed for specific mobility limitations is. The distinction matters because insurance coverage depends on items being classified as DME.

The Ordering Process

When your parent needs equipment, the process typically starts with a doctor visit. The doctor evaluates your parent, determines what equipment would be helpful, and writes a prescription. The prescription includes what equipment is needed and why, the medical diagnosis, and how long it's expected to be needed.

Your parent or you takes the prescription to a durable medical equipment supplier. The supplier is a company licensed to sell and rent medical equipment, often including delivery and setup services. They might be a physical therapy clinic, a pharmacy that also carries equipment, a large national equipment company, or a local medical supply store.

The supplier takes the prescription and verifies insurance coverage. They determine whether your parent's insurance will pay for the equipment, what portion they'll cover, and what your parent's cost will be. They might discuss options with your parent. A hospital bed might come in manual or electric. A walker might come in different styles. The supplier helps your parent choose what's appropriate for their needs and budget.

The supplier orders the equipment or pulls it from inventory, arranges delivery, and often sets it up in your parent's home. They provide instructions for use. They might explain maintenance or troubleshooting. They document the transaction for insurance.

Depending on the equipment and your parent's needs, they might rent rather than buy. Rental works well for temporary needs or if your parent is uncertain whether they'll use it. Some suppliers also carry used or refurbished equipment at lower cost.

Insurance, Rental Versus Purchase, and Cost

Insurance coverage varies widely. Medicare covers certain DME items when they meet specific criteria. Your parent needs a written prescription from their doctor. The prescription needs to document medical necessity. Your parent's doctor needs to be enrolled in Medicare. The equipment needs to be on the list of covered items.

Not everything is covered. Some insurance plans cover hospital beds but not lift chairs. Some cover walkers but not bathroom grab bars. You need to know what your parent's plan covers. The DME supplier can often look this up, or you can call your parent's insurance company directly.

Even when insurance covers equipment, your parent might have a copay or coinsurance. They might meet a deductible. Understanding the actual out-of-pocket cost matters for budgeting and decision-making.

Renting equipment usually costs less upfront than buying. You might rent for a few months while recovering from surgery or illness, then return it. Monthly rental costs for a hospital bed might be fifty to a hundred dollars. Buying the same bed might be a thousand dollars or more. Over years, buying is more economical. Over months, renting is.

Out-of-pocket costs for equipment without insurance can be significant. A wheelchair might cost a thousand or more. A hospital bed might be several hundred to several thousand depending on features. A lift chair might be a thousand to several thousand. Bathroom grab bars and toilet seat elevators are cheaper, in the tens to hundreds of dollars range.

Some equipment suppliers work on sliding scale fees for uninsured patients. Some community organizations offer used equipment. Some churches or service organizations have equipment lending programs. If cost is a barrier, exploring these options might help.

Working with Suppliers

Not all DME suppliers are equal. Some are responsive and knowledgeable. Some are poorly organized. Some pressure you into rentals that don't make sense. Some don't deliver when they say they will. Some don't set things up properly.

Ask for references. If your parent's doctor prescribes equipment, ask which suppliers they usually work with. They've had experience with these companies and can recommend ones that are reliable.

Call the supplier with questions. A good supplier is responsive and answers questions clearly. If you call and can't reach anyone, or get vague answers, that's a red flag.

Ask what's included. Delivery? Setup? Instruction on use? Warranty? Service if something breaks? These all matter. You don't want to get equipment home and not know how to use it or have nowhere to turn if it breaks.

Ask about their rental, return, and refurbishment policy. What happens if the equipment doesn't work for your parent? What are the fees for returning it? If they sell used equipment, what's the condition and what warranty comes with it?

Get everything in writing. The cost, what's included, the delivery date, what the warranty covers. Written documentation prevents misunderstandings.

Troubleshooting Common Issues

If insurance denies coverage, ask why. Ask the supplier or insurance company to explain the denial. Sometimes there's a way to appeal. Your parent's doctor might provide additional documentation. The supplier might request coverage in a different category. Sometimes the barrier is resolved with more information.

If equipment arrives and doesn't work properly, contact the supplier immediately. They should repair or replace it. This is their responsibility. Don't pay for equipment that doesn't work.

If setup is inadequate, ask for a revisit. A hospital bed should be set up so it works properly. A wheelchair should be fitted to your parent's body. A grab bar should be properly installed. If the initial setup isn't right, ask for correction.

If you need support after hours or on weekends, ask the supplier what their emergency protocol is. Some equipment needs working. If something fails and your parent can't manage without it, you need a way to get help.

The Bigger Picture

DME suppliers exist because people need equipment. The system exists to help people stay independent, manage their conditions, and live in their own homes. The system isn't perfect. It's complex, insurance coverage is variable, costs are high, and working through it requires persistence.

But when it works, it transforms your parent's life. The right equipment means your parent can continue living independently. It means they can manage their own bathroom needs. It means they can transfer safely. It means they can get in and out of bed without help. It means they stay home instead of moving to an institution.

Understanding the system, knowing what to ask, choosing good suppliers, and staying persistent when barriers come up makes the difference. The work is worth it. The result is your parent's continued independence and life on their own terms.

This article provides general information about the durable medical equipment system. Specific coverage, costs, and processes vary by insurance plan. Your parent's healthcare provider and their insurance company can provide detailed guidance for your parent's specific situation.