DME: From the Patient’s Perspective

  From the patient’s perspective, durable medical equipment (DME) can be both a blessing and a curse. The companies that supply the DME to the patient, often called DME providers, can also be a blessing or a curse to the patient, depending on the quality of service and product provided.

DME as a Blessing

  DME can help to alleviate the accommodations that a wound necessitates for optimal wound care. For example a special boot or wheelchair cushion may be needed to remove pressure from a wound and allow mobility, a raised toilet seat or commode chair may be needed temporarily to make toileting more comfortable, a wedge may be needed for positioning in bed or in a recliner chair, or a specialized mattress may be recommended for pressure reduction. Whether rented or purchased, if use of this equipment is fully covered by the patient’s insurer, all the better. This is seldom the case.

DME as a Curse

  DME adds clutter to a home. Mattresses, wheelchairs, toileting equipment, canes or walkers, boots, wedges or heel protectors, boxes of dressing supplies (not technically DME but cluttering nonetheless) – all add to the daily comings and goings of a family in a home. DME usually entails a co-pay by the insured, another financial obligation to a patient who may already be burdened by healthcare costs. DME can disrupt home life, for example altering sleeping arrangements when special support surfaces are needed.

  The quality of the DME provider is important to all patients, although less so to the insurers. Quality can be looked at from several aspects - service to the customer, responsiveness to inquiries, quality and function of equipment recommended or provided, complexity of billing, to name a few. Unfortunately, many insurers now contract with certain DME providers in a geographical area, taking away patient choice in favor of simplicity for the insurer – it’s easier for the insurer to do business with one large DME provider than many smaller ones.

  For example, this author’s insurance company would not provide a new wheelchair seat cushion through any local providers who had the product in stock, but would supply it only through a national provider who was two weeks back ordered on the product and whose phone staff were completely unknowledgeable about the product and tried to substitute a much inferior model.

  As in this case, oftentimes the provider is located far from the patient, eliminating the face-to-face contact that enhances a business relationship. This is especially important for patients dealing with a personal health problem and requiring equipment that is of an intimate nature. It is disconcerting to the patient to only speak with voices on the telephone rather than seeing people. In addition, a physical storefront or building when dealing with products the patient is not accustomed to, for a condition the patient may be reluctant to discuss at all.

  In addition, one DME company may not be able to provide all of the DME ordered. The insurer may have contracted with one company to provide wheelchairs, another to provide mattresses, and a third to provide canes and walkers. This can result in the patient having to interact with three different DME providers, meaning three different billers and three different deliverers to the home. Medical paperwork is confusing enough, without adding multiple providers and billing sources.

  It is important for the patient and the clinician to obtain good quality equipment. Oftentimes the DME provider will provide the lowest quality product available in order to maximize profit. Low quality products are usually not in the best interests of the patient. For example, there is good quality foam and there is cheap quick-crushing foam. Heel lift devices to protect the heels made from good foam will lift the heel off the bed while cheap foam will do nothing. However, they are both foam heel lifts. A good provider will provide a good product that works.

What Can the Patient Do?

  All patients must be ready to be strong self-advocates. Some DME providers really try to provide quality products and service. If a product or a provider is not working for a patient, the patient must be ready to be the very squeaky wheel that gets the grease.

  When dealing with DME providers, take a complaint to supervisors and managers. If resolution is not reached by phone, try e-mail. If resolution is not reached, put the complaint in writing on a sheet of paper and place it in the mail. Believe it or not, an old fashioned paper trail remains the single most effective means of resolving business issues. Keep documentation of every phone conversation with every person, their contact information, and the content of the conversation. Keep copies of all documents – prescriptions, letters, explanations from physicians or allied health, or from the insurer, letters or e-mails written.

  If resolution is not reached, enlist the services of the insurer. It is best to have one inside contact, so call customer service and ask for a case manager. Do all correspondence with the insurer through this case manager. This gives continuity to the complaint, and gives the patient a sole voice in a large faceless company with whom to work.

  Consider enlisting the physician in the complaint. A written letter describing the DME, the need, and the required function of the DME may be helpful in demonstrating the inadequacy of what is being provided. This author has found it helpful to pre-write at least parts of the letter for the physician to ensure the major points are covered.

  Stay strong. Complaining may not be an easy road, and is one of the many shortcomings of the US healthcare system, but resolution is possible.

Laurie M. Rappl, PT, DPT, CWS is currently an employee of Cytomedix, Inc. For more information email Laurie at lrappl@cytomedix.com.