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Linda
Brandwin, R.N.
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Linda
Brandwin
is a registered nurse and a medical billing
and claims specialist. For the past 10 years
she has worked directly with insurance companies
to give advice and guidance to the health care
consumer.
Readers may send email
or write Linda Brandwin at 5500 Single Oak Hill
Ct., Woodbridge, VA 22192.
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Hot
tubs may not be catagorized as durable medical equipment
Jan. 21, 2005
Q:
I
am trying to get some help with my insurance company
for aquatic therapy. The diagnosis codes are 715, 715.0
and 715.9. The doctor recommends a hot tub. It would
be better than going to the YMCA and getting physical
therapy every day. I need a procedure code so I can
purchase this medical equipment.
A:
Your
diagnosis codes indicate that you have osteoarthritis.
Health insurance companies sometimes provide coverage
for what is categorized as durable medical equipment.
I have never heard of a hot tub, or for that matter,
a swimming pool, being considered as durable medical
equipment. Usually DME items include wheel chairs, stools,
special mattresses or hospital beds, walkers, oxygen
equipment, prostheses, and things of this nature. You
need to check with your insurance company to see if
a hot tub would be covered if you have an appropriate
medical diagnosis.
If
you are lucky enough to have insurance that will pay
for a hot tub, the insurance company itself may have
the proper coding you need or the proper forms. Usually
the health care provider has to fill out this special
form for a DME request. Medicare, for example, calls
the form a certificate of medical necessity. This form
is given to the equipment supplier who can submit the
bill directly to your insurance company. Finding a hot
tub supplier that has had previous experience with health
insurance companies will make the process easier for
you.
If
your health insurance company does cover hot tubs, I
suggest you do whatever it takes to keep your coverage
with this particular company for as long as possible.
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