Frequently Asked Questions — Durable Medical Equipment (DME)
A reference page for patients, family caregivers, and healthcare professionals working with Moving Forward DME in Carmel, Indiana.
General DME Questions
What is durable medical equipment (DME)?
Durable medical equipment refers to medical devices and supplies designed for repeated use in a home setting, such as power wheelchairs, manual wheelchairs, bracing, and other mobility or support equipment prescribed by a physician. To qualify as DME for insurance purposes, equipment generally must be reusable, medically necessary, prescribed by a doctor, and primarily useful to someone who is ill or injured.
How do I get started with a DME provider?
The process typically begins with a physician's order or referral, followed by an evaluation (often with a physical or occupational therapist) to determine the right equipment for your needs. From there, your DME provider works with your insurance to secure coverage, fits and delivers the equipment, and provides training on its use. Moving Forward DME coordinates each of these steps directly with your physician's office.
What areas does Moving Forward DME serve?
Moving Forward DME is based in Carmel, Indiana, and serves patients across Central Indiana. Call 877.240.0777 to confirm service availability in your specific location.
Power Wheelchairs
How do I know if I need a power wheelchair instead of a manual one?
A power wheelchair is generally recommended when someone can no longer self-propel a manual wheelchair safely or without excessive fatigue, or when limited upper-body strength, endurance, or coordination makes manual mobility unsafe over the distances needed in daily life. A mobility evaluation with a physician or therapist is the best way to determine which option fits your specific situation.
Does insurance cover a power wheelchair?
Medicare, Medicaid, and most private insurers cover power wheelchairs when they are determined to be medically necessary for completing daily activities inside the home, not simply for convenience or getting around outside the home. Coverage requires documentation such as a face-to-face exam, a physician's written order, and often a specialty mobility evaluation. Requirements vary by payer, so it's worth reviewing your specific plan's criteria before starting the process.
How long does it take to get a power wheelchair approved?
Timelines vary by payer. Medicare requires delivery within 120 days of the qualifying face-to-face exam. Medicaid prior authorization typically takes 30 to 90 days depending on the state. Private insurance timelines vary by plan. Your DME provider can give you a more specific estimate once your paperwork is submitted.
How often should I charge my power wheelchair battery?
Charge the battery after every day of use, ideally overnight for 8 to 14 hours, using only the charger provided with the chair. If the chair sits unused for several days, give the battery a maintenance charge at least twice a week to prevent capacity loss.
Can a power wheelchair get wet or be used in the rain?
Most power wheelchairs can tolerate brief, light moisture, but they are not designed for prolonged rain or standing water. Extended exposure can corrode electrical components in the controller and wiring over time. If a chair does get wet, dry it thoroughly and let it sit in a warm, dry space for about 12 hours before relying on it again.
What should I do if my power wheelchair won't hold a charge?
This is usually a sign of battery wear and shouldn't be ignored, since it often gets worse quickly. Contact your DME provider to have the battery and charging system inspected, replacing a failing battery early is far simpler than dealing with a chair that stops working unexpectedly.
Manual Wheelchairs
What's the difference between a standard and a custom manual wheelchair?
A standard manual wheelchair is a general-fit device suited for short-term or lower-intensity use. A custom manual wheelchair is individually fitted to a person's body measurements, strength, and daily activity level, which improves comfort, posture, and long-term mobility for full-time users.
How is a manual wheelchair fitted?
Fitting involves measuring seat width, depth, and height along with the user's posture, strength, and mobility needs. For a custom manual wheelchair, this typically includes an evaluation with a physical or occupational therapist to ensure proper support, positioning, and ease of self-propulsion.
Does insurance cover manual wheelchairs?
Medicare, Medicaid, and most private insurers cover manual wheelchairs that are medically necessary for mobility inside the home, similar to power wheelchair coverage. Documentation typically includes a physician's order and, for custom models, additional clinical justification for the specific features required.
How long does a manual wheelchair typically last?
With regular care, most manual wheelchairs last 3 to 5 years, though the frame itself often lasts longer. Wear items like tires, casters, and upholstery may need replacement sooner depending on usage. Your DME provider can advise on repair versus replacement as your needs change.
How often can I get a new wheelchair?
Medicare typically covers a replacement wheelchair once every 5 years if it's still medically necessary and the current chair is beyond reasonable repair. Medicaid and private insurers generally follow similar guidelines, though specific timelines and documentation requirements vary by plan. Your DME provider can confirm your replacement eligibility based on your coverage and equipment history.
Insurance & Coverage
What's the difference in how Medicare, Medicaid, and private insurance cover DME?
Medicare follows a defined national process: a face-to-face exam within 6 months of the order, a written physician order, prior authorization for certain equipment, and delivery within 120 days. Medicaid covers similar equipment but is administered state by state, so specific forms, timelines, and criteria vary by state. Private insurance generally follows a similar overall structure but each plan defines "medical necessity" and network requirements differently, so it's important to confirm your specific plan's rules.
Why do DME insurance claims get denied?
The most common reasons include missing or outdated documentation (such as an expired face-to-face exam), paperwork that focuses on mobility outside the home rather than daily activities inside it, ordering equipment before prior authorization is approved, and using a supplier that isn't in-network or properly enrolled with the payer.
What can I do if my claim is denied?
Most denials can be appealed, and a large share of power wheelchair denials are overturned when the appeal directly addresses the specific reason stated in the denial letter. Appeal deadlines vary: generally 180 days for private insurance, 120 days for a Medicare redetermination, and a state-specific deadline for Medicaid. Your DME provider can often help prepare the appeal documentation.
Does workers' compensation cover DME?
Yes, when an injury covered under a workers' compensation claim requires mobility equipment or bracing as part of treatment or recovery, it is generally covered under that claim. Moving Forward DME has a dedicated Workers' Compensation Division that coordinates directly with employers, case managers, and adjusters on these requests.
What documentation do I need to bring to my doctor's appointment?
At minimum, expect to need a written order describing the equipment and diagnosis, and documentation addressing why the equipment is medically necessary for activities inside your home. Specific requirements vary by payer and equipment type, your DME provider can typically supply a documentation checklist matched to your specific insurance.
Maintenance & Troubleshooting
How often should DME equipment be cleaned?
A weekly wipe-down with a damp cloth (not a hose or sprayed cleaner) is generally sufficient for frames, seats, and controls. Pay extra attention to casters and wheels, which collect debris, and battery terminals, which can corrode and reduce charging efficiency.
How does incontinence affect wheelchair equipment?
Urine is acidic and can seep into seat cushions, seams, and wiring beneath the seat pan, gradually breaking down foam and corroding electrical components, often without any visible sign until a problem shows up. Using a washable, waterproof cushion cover and cleaning up spills promptly significantly reduces this risk.
When should I contact my DME provider about equipment problems?
Reach out any time equipment isn't performing as expected, a battery that won't hold a charge, unusual noises, sluggish controls, or visible wear on cushions or bracing. Small issues caught early are almost always simpler and less costly to resolve than problems left until the equipment fails.
For Healthcare Professionals & Case Managers
How can I refer a patient for DME evaluation?
Referrals can be made directly by contacting Moving Forward DME at 877.240.0777. Our team coordinates the mobility evaluation, documentation requirements, and insurance authorization process directly with your office.
What information helps speed up a DME referral?
Having the diagnosis, relevant clinical notes addressing in-home mobility limitations, and insurance information on hand at the time of referral helps move the documentation and authorization process along more efficiently.
Does Moving Forward DME work with discharge planners?
Yes. We regularly coordinate with discharge planners, case managers, and physicians to arrange DME setup and delivery timed to a patient's discharge or transition of care.
This page is intended for general education and does not replace medical advice or a specific coverage determination from your insurer. Coverage rules vary by plan, state, and individual circumstances. For questions about your specific situation, contact Moving Forward DME at 877.240.0777.
Tel: 877.240.0777 Fax: 877.347.5670