Durable Medical Equipment

What is Durable Medical Equipment?

Durable Medical Equipment is a certain type of medical equipment that is ordered by your doctor for medical reasons. Examples of durable medical equipment are walkers, wheelchairs or hospital beds.

What equipment is covered in my health plan?

Covered items include, but are not limited to: wheelchairs, crutches, hospital bed, IV infusion pump, oxygen equipment, nebulizer, and walker. The list below tells you the brands and manufacturers of durable medical equipment that Care1st Cal MediConnect Plan covers. Generally, Care1st Cal MediConnect Plan covers any durable medical equipment covered by Medicare and Medi-Cal from brands and makers on the list . We will not cover other brands and manufacturers unless your doctor or other provider tells us that the brand is right for your medical needs.

Members New to Care1st Cal MediConnect Plan

If you are new to Care1st Cal MediConnect Plan and are using a brand of durable medical equipment that is not on our list, we will continue to pay for this brand for you for up to 90 days. During this time, you should talk with your doctor to decide what brand is medically right for you after this 90-day period. (If you disagree with your doctor, you can ask him or her to refer you for a second opinion.)

Plan Coverage Decision

If you (or your doctor) do not agree with the plan’s decision about paying for your equipment, you or your doctor may file an appeal. You can also file an appeal if you don’t agree with your doctor's decision about what product or brand is right for your medical condition. (For more information about appeals, see Chapter 9 of your Evidence of Coverage Section 4)

Note: Authorization rules may apply for services. You should talk to your provider and get a referral. Contact Member Services at 1-855-905-3825 (TTY 711), 8am - 8pm, seven days a week, for details.