Introduction

So your doctor tells you that you need durable medical equipment (DME) — maybe a Group 2 Power Wheelchair, a Hospital Bed (Total Electric), or even a simple Cane for stability. What happens next?

Many people are surprised to learn that you can’t just pick up these items at a pharmacy, even with a prescription. Instead, most equipment requires a multi-step approval process involving your doctor, your insurance, and a DME supplier.

It can feel like a paperwork maze — prescriptions, insurance forms, medical necessity letters, and authorizations. The good news? Once you understand the process, it becomes much easier to navigate.

In this guide, we’ll walk through the full journey from prescription to delivery, step by step. Knowing what happens at each stage — and what you can do to help — will make the process smoother and faster.

Step 1: Doctor’s Prescription and Evaluation

Every DME request starts with a medical evaluation and a prescription from an authorized provider. Insurance will not pay for equipment without proper documentation of medical necessity.

Here’s what to focus on at this stage:

Discuss Your Needs Clearly

Be specific about the challenges you’re facing. For example:

• “I can’t safely climb stairs and need a hospital bed on the first floor.”
• “I get short of breath walking to the bathroom and need mobility support.”

These details help your provider document why the equipment is needed.

Obtain a Detailed Written Order

The prescription must be specific and accurate. Instead of “wheelchair,” it should state:

• Standard Manual Wheelchair
• Power Wheelchair with elevating leg rests

The order should include:

• Diagnosis or medical reason
• Provider signature and date
• Provider NPI number

Some insurers require structured forms, while others accept electronic or written prescriptions. Either way, detail matters.

Complete Any Additional Required Forms

Certain equipment requires more documentation. For example:

• Oxygen equipment often requires a Certificate of Medical Necessity (CMN)
• Complex mobility equipment may require physical or occupational therapy evaluations

If your supplier says additional forms are needed, help coordinate promptly. These extra steps are common — not a red flag.

Tip: Before leaving your appointment, ask for a copy of the prescription or visit summary and confirm which DME supplier your provider will send it to.

Step 2: Choose a DME Supplier and Submit the Order

Once the prescription is written, the next step is choosing a DME supplier.

Verify Insurance Requirements

Insurance plans often limit which suppliers you can use:

• Medicare requires Medicare-enrolled suppliers
• Medicaid and private plans usually require in-network suppliers

Always verify supplier eligibility with your insurance before moving forward.

Send the Prescription

Your doctor’s office may fax or electronically send the order directly to the supplier. Follow up to ensure it was received. Some suppliers also accept patient-submitted copies.

You’ll typically complete a patient intake form with:

• Insurance details
• Contact information
• Consent to bill insurance

Assignment of Benefits

Most suppliers will ask you to sign an Assignment of Benefits (AOB) form. This allows them to bill insurance on your behalf and outlines your responsibilities, such as coinsurance or rental terms.

This paperwork is standard — ask questions if anything is unclear.

Experienced suppliers may also flag potential insurance issues early. For example, if a Wrap-Around Hinged Knee Brace requires proof of failed conservative treatment, they may request therapy notes upfront to avoid delays.

Step 3: Insurance Authorization and Documentation Review

This is the behind-the-scenes phase where most of the work happens.

Submission to Insurance

The supplier submits the request using:

• The doctor’s prescription
• Medical records and progress notes
• Equipment billing codes and justification

Medicare often reviews documentation after delivery, while Medicaid and private insurers usually require approval first.

Insurance Review Timeline

Approval timelines vary:

• Simple items may be approved quickly
• Complex equipment may take several weeks

Insurers review whether the request meets coverage criteria.

Requests for Additional Information

It’s common for insurers to request clarification — such as height, weight, test results, or visit notes. Responding quickly helps prevent delays.

Approval or Denial

• Approved: The supplier schedules delivery
• Denied: The insurer explains why

Denials are often fixable. Missing documents, evaluations, or clarification can usually be addressed through resubmission or appeal.

A denial is not the end of the road.

Step 4: Equipment Delivery and Setup

Once approval is complete, delivery is scheduled.

Delivery and Scheduling

Small items may be shipped or picked up. Large or complex equipment is delivered and set up in your home by trained technicians.

Training and Education

Suppliers are required to show you how to use the equipment safely. Ask questions and request demonstrations.

Examples:

• Operating hospital bed controls
• Assembling and cleaning a nebulizer
• Charging and driving a power wheelchair

You’ll usually receive written instructions and sign that training was provided.

Verify What You Received

Confirm that:

• The equipment matches the prescription
• All accessories are included
• Rental items are clearly identified

If something is missing or incorrect, address it immediately.

Paperwork and Financial Responsibility

You’ll sign a delivery acknowledgment. This also serves as proof of delivery for insurance.

If you owe any copay or coinsurance, the supplier will explain how and when payment is handled.

Step 5: Follow-Up and Staying Organized

Once your equipment is in place, a few ongoing responsibilities help keep coverage smooth:

Keep Important Documents

Store copies of:

• Prescriptions
• Approval letters
• Delivery receipts

These are useful for renewals, repairs, or replacements.

Track Maintenance and Renewals

Some equipment and supplies require:

• Periodic reauthorization
• Annual prescription renewals

Many suppliers help manage this, but calendar reminders are helpful.

Use Equipment as Prescribed

Continued coverage may depend on documented use and benefit — especially for oxygen or CPAP equipment.

If the device isn’t working for you, report issues rather than stopping use.

Report Changes Promptly

Notify your supplier if:

• Your insurance changes
• You move
• You no longer need the equipment

This prevents billing issues and eligibility problems later.

Conclusion

Getting DME approved involves multiple steps and coordination between providers, suppliers, and insurers. While the process can feel overwhelming, understanding each stage puts you in control.

Start with a strong prescription, work with experienced suppliers, and stay engaged throughout the process. Paperwork and approvals may take time, but they exist to ensure appropriate care.

With patience and persistence, you’ll move from prescription to delivery — and end up with the equipment that helps you live more safely and comfortably at home.