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Medicare & Private Insurance

HME Medical does not bill Medicare or other insurance companies directly; however, by the following these steps you may be able to receive up to 80% reimbursement on certain products (see qualifications below). Please note that these guidelines apply generally but do not constitute a guarantee of reimbursement approval. For exact eligibility information please contact Medicare or your insurance provider directly.

In cases of eligibility, to secure reimbursement you will need to submit a doctor’s prescription for the item ordered; proof of delivery, such as a packing slip or shipping receipt; and, in some cases (for Medicare reimbursements), Form 1490.

Eligible products for reimbursement
Medicare eligibility requirements vary from product to product. Therefore, please read the guidelines below to determine whether your specific product qualifies for Medicare reimbursement. For other insurance providers, please contact the company directly to ascertain their policy for each item.

Power Wheelchairs and Mobility Scooters To qualify for a power wheelchairs and mobility scooters reimbursement, a patient must meet the following criteria:

  • The patient must suffer from mobility-related limitations on daily living activities, such as eating, bathing, dressing, etc.
  • The condition being addressed by the mobility device must be the exclusive cause of the above limitations, (for example, not by vision or cognition impairments), unless these can be addressed through caregiver support. (Please note: To qualify for a power wheelchair, it must be demonstrated that the added features of this device would be critical in helping the patient perform one or more of the above mobility-related daily living activities.)
  • Simple devices such as a cane, walker or manual wheelchair would not sufficiently address the mobility limitation.
  • The patient demonstrates an ability to operate the device safely. (For a scooter, this includes possessing the necessary strength and postural stability.)
  • The patient’s environment must allow for the use of a power wheelchair or scooter in all places where the mobility-related activities of daily living normally occur (i.e., kitchen, bedroom, bathroom).

Lift Chairs
To qualify for a lift chair reimbursement, a patient must meet the following criteria:

  • Patient must suffer from major arthritis of the hip or knee, or from a severe neuromuscular disease.
  • Patient must be incapable of reaching a standing position on his/her own from a standard armchair in his/her home. (Please note: Medicare does not qualify a patient who has difficulty rising from an arm-less chair, particularly a low one, but could rise on his/her own from a raised chair or one with arms. The chair lift reimbursement covers only those who cannot rise at all from an arm chair.)
  • Once standing, the patient must have the ability to walk.

Note that, even in qualifying cases, Medicare covers only the seat-lift mechanism itself (typically up to $300, depending on the state). In addition, the patient’s attending physician for the condition under treatment must also be the prescribing physician for the chair lift.