Advocacy Committee

Don't Give Up on Getting the Equipment You Need!

ASCIP understands the importance of having access to the right medical equipment and devices to maintain your health and independence. However, navigating insurance coverage for these items can be frustrating.

Here's some information to help you:

If you're having trouble getting coverage for:

• Transanal irrigation (TAI) systems: ASCIP supports medicare coverage of TAI and is working closely with other advocacy organizations to move the needle closer to medicare coverage of TAI. These systems can significantly improve quality of life for those managing neurogenic bowels. Check your insurance policy details regarding Durable Medical Equipment (DME) coverage. You may need a doctor's referral and prior authorization. We have a sample letter that may be useful in attempting to get insurance coverage for TAI.
• Custom power and manual wheelchairs: Custom wheelchairs are often medically necessary for individuals with specific needs. Again, refer to your DME coverage details and speak with your doctor about obtaining a prescription.  We have provided some useful information to provide to your doctor to assist in obtaining this much needed equipment:
  • Click here for information about power wheelchairs. 
  • Click here for information about manual wheelchairs.  
• Urological supplies: Catheters, drainage bags, and other urological supplies may be covered under your insurance plan. Contact your insurance provider directly to understand specific coverage guidelines and requirements. Click here for some useful information to provide to your doctor to assist in obtaining this much needed equipment.

Home Health Coverage Nuances:

• Medicare: Medicare Part B (outpatient/medical insurance) may cover some home health services and medical equipment, but it typically requires a doctor's certification of medical necessity. Our pamphlet on home health coverage could assist you in understanding the nuances to what is and is not covered by Medicare
• Private Insurance: Coverage for home health services and equipment varies widely between private insurance plans. Carefully review your policy details to understand what's covered, pre-authorization requirements, and potential co-pays or deductibles. Often private insurance coverage is similar to Medicare so understanding nuances may be useful.

If you're a Veteran

The VA offers comprehensive healthcare benefits, including coverage for medical equipment and devices related to service-connected disabilities or catastrophic injuries. Here is some useful information to assist you in your journey to independence.

Remember, you have a right to understand your insurance coverage. Don't hesitate to appeal denied claims and advocate for the equipment you need.