Durable medical equipment (DME) is a type of medical equipment that your doctor orders for medical reasons. Examples of DME are walkers, wheelchairs, and hospital beds.
Equipment covered by Blue Shield Promise Cal MediConnect plan
Covered items include, but are not limited to:
- Hospital bed
- IV infusion pump
- Oxygen equipment
We will pay for all medically necessary DME that Medicare and Medi-Cal usually pay for. If our supplier in your area does not carry a particular brand or maker, you may ask them if they can special-order it for you.
In certain situations, Blue Shield Promise Cal MediConnect Plan may transfer ownership of DME to you depending on if you meet one or all of the following criteria:
- You have a continued medical need for items costing less than $150 and/or parenteral/infusion pumps,
- Physician certification, or
- If the device or equipment is made to fit you
In certain situations, we will transfer ownership of the DME item to you. Call Customer Care to find out about the requirements you must meet and the papers you need to provide.
Plan coverage decision
If you or your provider don’t agree with Blue Shield of California Promise Health Plan’s coverage decision, you, your representative, or your provider may file an appeal. You can also file an appeal if you don’t agree with your provider’s decision about what product or brand is appropriate for your medical condition.
For more information about appeals, see Chapter 9 of your Member Handbook, which explains what to do if you have a problem or complaint.
NOTE: Authorization rules for services may apply. For details, call Customer Care:
Phone: (855) 905-3825 [TTY: 711], 8 a.m. to 8 p.m., seven days a week