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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 Health Plan covers. Generally, Care1st Health Plan covers any durable medical equipment covered by Original Medicare from the brands and manufacturers on this list. We will not cover other brands and manufacturers unless your doctor or other provider tells us that the brand is appropriate for your medical needs.

Members New to Care1st Health Plan

If you are new to Care1st Health Plan and are using a brand of durable medical equipment that is not on our list, we will continue to cover this brand for you for up to 90 days. During this time, you should talk with your doctor to decide what brand is medically appropriate 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 provider) don’t agree with the plan’s coverage decision, you or your provider may file an appeal. You can also file an appeal if you don’t agree with your provider’s decision about what product or brand is appropriate for your medical condition.

(For more information about appeals, see Chapter 9 of your Evidence of Coverage, What to do if you have a problem or complaint (coverage decisions, appeals, complaints).

Note: Authorization rules may apply for services. Contact Member Services at 1-800-544-0088 (TTY 711), 8am - 8pm, seven days a week, for details.