Durable Medical Equipment
Both HMO Illinois and BlueAdvantageSM HMO include coverage for durable medical equipment (DME).Durable medical equipment is "durable equipment which primarily serves a medical purpose, is appropriate for home use and generally is not useful in the absence of injury or disease." Examples of DME are wheelchairs, hospital beds and ventilators.
If a member's PCP determines that he or she needs DME, the PCP will write out a prescription and a referral will be made to a contracting provider. The member simply gives the supplier the prescription and shows his or her BCBSIL HMO member ID card to obtain the equipment.
The DME provider will usually file a claim directly with BCBSIL. However, some DME providers may require members to pay for the equipment then submit a claim to the BCBSIL HMO for reimbursement.
Equipment Not Covered
DME benefits exclude comfort or convenience items commonly used for purposes that are not medical in nature, such as (but not limited to) air conditioners, humidifiers, physical fitness equipment, televisions or telephones.