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Durable Medical Equipment – Another Excuse to Deny PIP Payments?

Durable Medical Equipment | Lyle B. Masnikoff, P.A

A recent trend we have noticed with PIP insurers is their overly broad use of denials based on a failure to have a proper license to sell durable medical equipment. There is some equipment that does require a license to sell durable medical equipment, such as a TENS unit. However, insurers have been using this tool to deny reimbursement for other equipment that does not fall under the category of durable medical equipment. One such type is back braces.

Pursuant to ACHA’s definition of durable medical equipment, it “does not include prosthetics or orthotics or any splints, braces, or aids custom fabricated by a licensed health care practitioner … [t]hus, a provider that sells or rents prosthetics or orthotics exclusively would not need [a home medical equipment license].”

Despite such facts, a number of insurers are trying to use this loophole in order to deny the payment of proper claims. Please contact our office at 877-817-4127 if you have any such denials, and we can guide you on whether you need a license or not.

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