Durable Medical Equipment in Health Insurance

Durable Medical Equipment (DME) refers to items used by medical practitioners for treatment and patient care. Such devices differ from regular medical equipment as they are intended for repeated use for an extended period. As surgical items and medical procedures are covered under health insurance, some insurers may include DME in their healthcare policy. This article explains durable medical equipment in health insurance, including its meaning, common examples, eligibility criteria, and claim process. It helps readers understand which medical devices are covered, how coverage works, and what exclusions may apply under different health insurance plans.

Some of the common categories in the durable medical equipment list are:

Infusion pumps and supplies 

Infusion pumps are used to administer intravenous (IV) fluids.  They are used to introduce medication or nutrient supplements directly into an individual’s bloodstream. A tube inserted into the vein makes this possible.  They are used for a wide range of conditions, including delivering medication before or after surgery or when oral intake is not possible.

Mobility aids

Mobility aids are recommended when an individual has physical disabilities or difficulty walking due to an accident. They include wheelchairs, walkers, canes,  knee walkers, and crutches. The extent of use depends on your condition, which determines if they are covered by health insurance.

Hospital beds

Hospital beds are provided during hospital admission when constant medical attention is required. The cost of hospital beds is usually covered under the room rent. Hence, health insurance providers may cover it based on the room rent limit specified in the policy.

Patient lifters

As the name suggests, patient lifters are equipment used to move patients from one place to another. Several options are available, most featuring advanced technology and hydraulic systems to ensure seamless transfers. They are particularly useful for patients who are injured, immobile, or recovering from surgery. 

Ventilators

Ventilators enable patients to breathe when they are unable to do so independently. They are usually used when a patient is recovering from surgery or has a condition that affects breathing. As they are part of the treatment, the cost of ventilators is typically included in ICU charges.

Oxygen concentrators

An oxygen concentrator is a machine used for assisting with shortness of breath. It supplements extra oxygen to compensate for the low oxygen levels in the body. The device includes a compressor, oxygen tank, pressure valve, and mask. If prescribed by a medical practitioner, the cost may be covered as part of the treatment, depending on the policy terms. 

Blood sugar test trips and monitor

Individuals with diabetes can manage their blood sugar levels at home using blood sugar test strips and a glucometer. The test strips are used to collect blood samples, while the glucometer displays the readings. Coverage for these devices depends on the insurer and the specific policy terms.

Dental equipment

Dental equipment may be required in cases of injury or dental complications. Devices such as braces, mouth guards, and dental bridges are commonly used for corrective purposes. Most insurers do not cover dental equipment unless it is required due to an accident, and coverage depends on policy-specific conditions.

Follow the below-mentioned steps to claim insurance benefits for the medical equipment: 

• Fill out the respective form: On the insurance website/ mobile app, various claim forms are available. Download the form for medical equipment expenses and fill it out accurately.
• Mention need and usage: The form includes multiple sections, some of which require you to describe the medical need and the expected duration of use of the equipment. Additionally, you must specify whether the equipment is to be purchased or rented.
• Submit necessary documents: In addition to the form, you must provide supporting documents, such as the doctor’s prescription for the equipment and the related bills. This adds credibility to your claim request. 

Note: Once you submit the claim request, the insurance company will review it and may call you to verify the details. On successful completion of all formalities, they will approve your claim request. 

Insurance providers in India may or may not offer coverage for durable medical equipment. It depends on their policy and if it is medically necessary to include it as prescribed by the doctor. If they do, the extent of coverage and the specific types of DME covered may vary. Hence, it is best to check the terms on the insurers' websites while buying health insurance online. You can go through the list of inclusions and exclusions in the policy wording, and get clarity on the durable medical equipment list covered.

You can also explore plans from SBI General Insurance for clear policy terms and comprehensive coverage options.

1. What is considered durable medical equipment in health insurance?

Common examples of durable medical equipment include diabetes monitoring machines, infusion pumps, oxygen equipment, etc.  

2. Does health insurance cover wheelchairs?

Some health insurance plans may cover the cost of wheelchairs. However, check the fine print of your policy for specific details. 

3. Is oxygen equipment covered under health insurance?

Yes, oxygen equipment is generally covered when prescribed as part of the treatment. However, it varies from one policy to another. Check your policy for precise information.