a) This policy will apply to all services performed
on or after the above revision date which will become the new effective date.
b) For all services referred to
in this policy that were performed before the revision date, contact customer
service for the rules that would apply.
durable medical equipment (DME) is covered when the patient owns the equipment
(rather than renting it), the damage was not caused by neglect or misuse, the
equipment is not currently covered by warranty, the repair is necessary to make
the equipment usable, and the cost of the repair does not exceed the cost of
purchasing a replacement piece of equipment.
Replacement of DME is covered when the patient owns the
equipment (rather than renting it), the equipment has been rendered unusable,
the damage was not caused by neglect or misuse, the equipment is not currently
covered by warranty, and the cost of repair exceeds the replacement cost.
Replacement of current DME due to end of warranty is not covered. Upgrading to
newer models with new functionality (irrespective of warranty) is not covered if
current DME is functional.
In general, repair and replacement of DME does not require prior
authorization. However, please refer to prior authorization list or specific
medical policies at QualChoice.com for items that require prior authorization.