Tips & Advice
What is a DME claim?
A durable medical equipment (DME) claim is a form you fill out to get reimbursed for expenses that you paid for and are covered by insurance. If you bought something directly from the supplier, and it qualifies, you can be reimbursed by Medicaid insurance.
Which medical supplies are covered through Medicaid?
Medicaid will cover necessary durable medical equipment that your doctor prescribes for your in-home use. They must be durable, used for a medical reason, not typically useful to someone who isn’t sick or injured (like crutches or a wheelchair), is used in the home, and has a minimum of a three-year life expectancy. If your condition has extenuating circumstances, you can file a claim or speak to a Medicaid rep to discuss your options.
What are consumable medical supplies?
Consumable medical supplies are either disposable, or unable to withstand repeated use. They are items that get used up, and generally fall into the categories of bandages, antiseptics, and skin preparations. These are usually one-off products that cannot be reused.
Are medical supplies covered by insurance?
Most insurance companies and policies cover equipment that is prescribed by a doctor to treat or assist a patient in need. There can be exceptions and coverage might not necessarily be 100%, so the only way to know for sure r is to consult your policy or insurance rep. Most items of real need are covered. Supplemental insurance can offset many costs not covered by a standard policy. The good news is that if a doctor prescribed it, you are likely covered.
What is durable medical equipment?
There are two main types of medical equipment: disposable and durable. Durable medical equipment provides therapeutic benefits to a patient who is in need because of an illness or medical condition. Durables are usually reusable items, including beds, wheelchairs, breathing machines, canes or crutches, and monitors.
How much does it cost to see a pulmonologist?
The cost to see a pulmonologist can vary depending on several factors, starting with the cost of the appointment. This can range from around $50 on up, depending on location, etc. You will likely have to take, at a minimum, a spirometry test which records the rate and amounts of air inhaled and exhaled. This initial test is used to diagnose lung conditions. From there your doctor may have to have more tests to further diagnose your condition. If you are paying out-of-pocket, you can expect a minimum cost of your office visit and spirometry test. Obviously additional tests, severity of condition, and other variables can influence your cost. Pulmonologists are usually billable under most insurance plans, but consult your policy or insurance representative to understand what your plan covers.
Pneumonia is an infection of one or both of the lungs. There is no singular cause of pneumonia, making it a common and dangerous ailment. There are more than 30 germs, bacteria and viruses that can cause it. The usual symptoms of pneumonia include coughing with phlegm, fever and chills and difficulty breathing. The air sacs in the lungs may fill with fluid and this is when it can be very dangerous and potentially fatal. Pneumonia is especially dangerous in infants, people older than 65, and people with reduced immunity. It is usually treatable with antibiotics and over the counter medicines and can sometimes be prevented with vaccines.
Cystic Fibrosis, or CF, is a genetically-inherited progressive respiratory disease that damages the lungs and digestive systems. As the disease progresses, frequent infections limit and reduce the ability to breathe. The defective gene causes production and buildup of thick mucus in the lungs, pancreas and other organs, due to a defective gene that produces a protein called the CFTR. Symptoms may include frequent lung infection, a persistent cough that produces thick mucus, breathlessness, intolerance to exercise, and frequently inflamed sinuses or nasal passages. Due to the seriousness of CF, it is standard now for all newborns to be screened for it. CF is a life-threatening disease that can be treated to ease the symptoms, but ultimately cannot be cured.
Bronchitis is an illness caused by a viral infection in which the lining of the bronchial tubes in the lungs become inflamed, causing reduces airflow capabilities to and from the lungs. Primary symptoms of bronchitis and acute bronchitis are chronic or persistent cough, and coughing up mucus. These can also be symptomatic of other respiratory conditions, so be sure get a correct diagnosis from your physician. Bronchitis is easily treatable and can take a few days or even weeks to fully recover depending on the strength of the strain, time of diagnosis and the person’s health and recovery abilities. You can treat bronchitis on your own without medical attention, assuming it is not an extreme condition.
Sleep apnea is a sleeping disorder in which a person’s breathing is interrupted or stopped during sleep. Sleep apnea can be dangerous because the lack of breathing deprives the body and brain of crucial oxygen. Symptoms of sleep apnea may include loud snoring and feeling tired, even after a full night’s sleep. These can also be symptoms of other respiratory conditions, and even be harmless coincidences, so be sure to consult your physician for clarity and proper diagnosis. Age and obesity are primary risk factors for sleep apnea and it is more common in men. Sleep apnea treatments include lifestyle changes such as diet and exercise, and the use of breathing assistance (CPAP) machines at night.