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Under the Affordable Care Act, many insurance plans are required to cover a range of essential services, such as hospitalizations and prescription drugs. But durable medical equipment isn’t among them, except for breast pumps, which most plans must cover.
These days, insurers often contract with selected medical supply companies to provide equipment, just as they negotiate rates for other services. But patients often don’t realize that, said Alice Bell, a physical therapist and senior payment specialist at the American Physical Therapy Association, a professional group. Patients who don’t use an insurer’s preferred provider may be charged a higher rate or have to pay the entire amount out-of-pocket, she said.
“It’s important to make sure the supplier is in-network, even if the doctor prescribes it, because it varies,” Bell said.
When Bruce Lee, 48, strained a ligament in his left leg, his doctor prescribed a walking boot and gave him a list of medical suppliers. The doctor warned Lee to make sure he chose one in his insurance network.