Health Insurance doesn't cover DME Durable Medical Equipment
Last night I went online and read my "official coverage document" (why can't they just call it the "contract"?) and I was very confused. It seemed to say under the "Exclusions" section, in bold lettering that Durable Medical Equipment (DME) was excluded from coverage. Huh? How could that be? So I spent a good hour or two searching the 231 page document and finally decided to give up and call member disservice in the morning. Sure enough, "I'm sorry, but your plan excludes all DME unless the particular equipment is mandated under state law." Wow. Even though I read the contract I couldn't believe it, so I was still really surprised when the representative confirmed it. I asked if this was a common thing and the rep said: "Well, I wouldn't say it is common, but I've seen it before." I thought it was a mistake. How could Joan's employer opt for such a deal? "Funny thing" is, there are two sections in the contract. One section is for their employees in their home state. The other is for their employees in our state. The home state section covers DME, our state section excludes DME. Joan is their only employee in our state. Joan and I pay more than $500 per month out of pocket for our premium. We have a $30 co-pay when we see any doctor and also for certain procedures and lab tests. Grrrrrr Anyone else have a plan (or hear of a plan) that excludes DME??? |
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| It's not an "uncommon" exclusion. During my brief foray some years back into Case Management I was amazed at the number of Insurance Companies that do not cover DME. DME can be something as simple as an arm splint or something as necessary as a billi blanket for a newborn. In some cases the "out of pocket" expense was minor but in other cases I actually saw the patient have to spend extra days in the hospital because the needed equipment was not covered "out of hospital:. |
| When I was pregnant with Gabe we were using Vic's new
insurance for the first time. My glucometer was covered, but they got to choose which one I got. Fine. A month later the policy had changed and NONE of my stuff was covered. In the papers they sent us it was all clearly covered, however upon calling the 'disservice' center I found out that the employer had opted out of all diabetic supplies. Not only that but my insulin was then supposed to be ordered and mailed to me. That doesn't work when they sometimes changed my Rx more than once a week. I do not understand why employers make the changes they do, or why they opt to single out one employee. I would have a melt down if I were you. You would think that if someone needs something be it a DME or other supplies that supplying them would really seem preventative to further problems! If I ruled the world...... Shellie |
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