There once was a time when your DME provider was there from delivery of your wheelchair through years of servicing, all the way to ordering a new wheelchair the next time around. In fact, many of us had the same DME provider for decades as we transitioned from wheelchair to wheelchair. We knew where to go, who to call, and service was certain.
Today, however, we live in a far different funding climate — one that is responsible for closing many local DME providers, has limited access to service, and has left many consumers asking a disconcerting question: Now what do I do?
It’s a tough time in the mobility market when it comes to maintaining a DME provider. However, by understanding the changes, and how to promptly address them, you can help preserve your access to mobility technology and service.
How the DME Provider Market is Changing
Competitive bidding, where Medicare puts DME goods up for bid, then selects the lowest-cost bidder in a region to be the sole retailer, is being phased in nationally, removing the ability for all but bid-winning providers to supply many Medicare-funded DME goods. Additionally, there’s a domino effect, where although DME providers may accept private insurance, Medicare and Medicaid funding is such a large overall funding source that many DME providers have been stripped of much of their business. Many long-time, local DME providers who haven’t won bids have simply gone out of business, leaving consumers to move to a regional bid-winner or seek out another provider — a perplexing and troublesome shift for consumers.
Interestingly, while any provider can still service DME goods, since competitive bidding mainly directs consumers to bid-winners for new products, funding rates for repair service have been capped by Medicare. The result is that many DME providers can no longer afford to service mobility products on a routine basis. Whereas you once could call your DME provider and get prompt service, now they may only service your area and mobility product on a bi-weekly or monthly basis, leaving you without repair until it fits their calendar schedule.
How You Can Get the Service You Need
Medicare and Medicaid require that a DME provider has the complete medical and technology history file of a consumer in order to receive payment for service and repairs. Providers who sell new mobility products have all the documentation to begin with, and keep that file to receive funding for service and repairs. However, many consumers are finding themselves in a bind: When providers go out of business, they usually destroy each consumer’s file, or refuse to hand it over. After all, legally, it’s their property. Unfortunately, then, in order for a consumer to obtain service from another provider, the consumer must start all over gathering records, beginning with a doctor’s prescription — a logistically inconvenient nightmare, especially when one has a wheelchair that’s sitting broken.
For those in Round 1 competitive bidding areas, this nightmare of having to redo documentation is already occurring. However, with Round 2 not yet started, there are three important steps consumers can take to be proactive.
1. Immediately contact your provider and request a copy of your mobility history file. This way, should you have to change providers, you’ll have all that’s needed for a smoother transition.
2. When purchasing a new mobility product, it’s vital to make copies — from the doctor’s prescription onward, and create your own file of each document as you go. Should you ever have to change DME providers — and many of us will have to as the competitive bidding plan spreads nationally — you’ll have all that’s needed for the switch.
3. If you are shopping for a new DME provider, explicitly ask about service and repair protocols and schedules, finding one that’s the most prompt.
Indeed, changes in the DME provider market are affecting consumers’ access to service. However, not all is lost. By understanding how to address current changes and preparing for future ones, you can ensure that the service and repairs you need to keep you mobile will still be available.