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DO I qualify for a Hospital Bed?

Posted by Kevin Brown on

Do you know what the toughest product to qualify for now a days is? It's Hospital Beds! In this video I go over the guidelines and qualifications along with showing the features on a fully electric hospital bed. Please enjoy and don't forget to share.  I have also attached a recent blog that goes into detail on the different types of hospital beds. Click here for it  https://www.allstarmedicalllc.com/nashvillemedicalsupplies/everything-you-need-to-know-about-hospital-beds/ 

Hey, this is Kevin with All-Star Medical and today I wanna go over something we get a lot of questions about, and it's hospital beds. We are strictly a retail-only company. We get a lot of people that come in here and want to get a hospital bed covered by insurance. And over the years the guidelines have been more and more stringent and they're tougher to meet.

So what I wanna do today is show you all the features of a hospital bed. Then I also wanna go over the criteria of a hospital bed, that way you can understand where the information comes from. I'm even gonna show you the link for Medicare's website to show you all the qualifications. And that way you can reach out and talk to your physician, talk to your insurance company. Because most insurances actually follow Medicare guidelines. But just check with them, make sure that is, you know, the same factor that goes into play there. I get a lot of people that will call their insurance and say, "Do you cover hospital beds?" Or, "Do you cover whatever piece of equipment?" And they say yes. And, you know, that is because they do cover it. But you have to ask the next question is, "What is the medical qualification and the criteria for me to cover or have the bed covered by my insurance?" That's the key part that people forget. People will get a prescription from their doctor and be like, "Well, my doctor wrote an order for it." That means nothing. That's a starting point. Your doctor does not have any sorta power like they used to 10, 15 years ago. Just because your doctor wrote it really doesn't mean anything. It's all about will insurance cover it. So that's what I'm here to talk about today.

But to start out with the bed, there's a couple different type beds you can get. Insurance only pays for a semi-electric. A semi-electric bed has features where it will raise the head of the bed and then it will also raise the feet, okay? That's the only two things that are covered by insurance, is a semi-electric bed.

The bed I have here is a fully electric. Really the main difference is if you look down here, I can raise the entire height of the bed up or down. This comes in really handy when somebody might be transferring from a chair to bed, or wheelchair to bed, or just, you know, maybe they're not very tall, something of that nature. Makes it easier to transition to, see as it rolls down?

So if you have a semi-electric bed the only way to do it is that crank system and hand crank the height up. So that's the big difference there. Most of your beds are gonna come with half rails, you can get full rails, which come out to extend about right here where my knee is over. The rails can go up or down real easy, they lock in place. This bed actually comes in a couple different parts. Everybody thinks it's a really hard thing to deal with. But underneath here, you'll see it's actually two frames plus the head and footboard that get put together plus the rail.

Right here we have a five-inch foam mattress. This is by Drive Medical. Typically, you're gonna see innerspring mattresses. To be honest with you, they're not a very comfortable mattress. If you're wanting something, you want a foam mattress. Most people, that's a big transition issue that we have. People coming from a regular bed, then they go into a facility, whether that's a hospital, or a rehab center, nursing home, something like that for a little bit of a stay, they go from their nice bed to most of your facilities have a foam mattress. And then they go home and sometimes get an innerspring. So it gets less and less comfortable. So that's where we try to always do a fully electric bed with a foam mattress. We rent these short-term and we also do purchases of them. So we try to figure out what works best. Because if you don't meet the qualifications by insurance, it doesn't mean you don't need a hospital bed. You still might have to pay out of pocket for one and that's where All Star Medical can come in and help you out.

You can also get larger beds. There are beds that have a weight capacity of 450 to 650. You have to weigh over 350 pounds in order to qualify for a bariatric bed. They're a little bit wider. Your standard bed is 36 by 80, your bariatric bed is 42 inches by 80 inches. And they even have a 1,000-pound bed that is, I believe, it's 54 by 80. So again, you gotta have certain weight requirements in order to meet that. Just because you're used to sleeping in a queen size bed doesn't mean you can get a queen size hospital bed covered by insurance. You're gonna get a home care bed similar to this which is twin long, 36 by 80.

A couple of the other factors that I want to show you where I got my information from. I've got the computer up here and as you can see, this is Medicare's website or cms.gov. It's their Medicare coverage database, okay. And what this does is it show you the local coverage and determination for all sorts of different products. And I've printed off the sheet here to kinda show you what the qualifications are for that.

So it starts out with a fixed hospital bed is covered if one or more of the following criteria are met. Okay, so down here are the four criteria. "The beneficiary has a medical condition which requires positioning of the body in ways not feasible with an ordinary bed. Elevation of the head, upper body less than 30 degrees does not usually require the use of a hospital bed." So basically, what they're telling you is you can just use a bed wedge and you don't qualify. So that's what they're gonna give you, some sorta wedge or tell you to do a wedge, and that is not covered. The second question is, "The beneficiary must require positioning of the body in ways not feasible with an ordinary bed in order to alleviate pain." Again, they're gonna say some sorta bed wedge or something can be done in a regular bed and they're not gonna cover it. The third one is probably where most people qualify for it but it's limited to the diagnosis. "The beneficiary requires the head of the bed to be elevated more than 30 degrees most of the time due to congestive heart failure, chronic pulmonary disease, or problems with aspiration," okay. Then the next one is, "The beneficiary requires traction equipment which can only be attached to a hospital bed." There's not many things nowadays that is not free standing. So a trapeze bar is free standing. So they will say, "If you just need the trapeze bar, you can get a free standing trapeze bar." So they're not gonna cover the bed based on that. So you're gonna have to have one of those three diagnoses in order to qualify for it in the most part. So it's very tough criteria and, you know, we're seeing more and more people need to rent them for short-term use and things like that, and that's where we can come in and help you out.

Some of the other guidelines that I have down here just to touch base. You know, that says a fixed height hospital bed but I wanna show you, as it goes down it says, "A variable height hospital bed is covered if they meet the fixed height hospital bed. A semi-electric hospital bed is covered if they meet the criteria for a fixed height hospital bed." So that's why I have touched base on that main part up there because it's the same qualifications. And again, I had touched base earlier on, "The heavy duty, extra wide hospital bed is covered if the beneficiary meets one of the criteria for a fixed hospital bed and the beneficiary's weight is more than 350 pounds but does not exceed 600." So the next one, the larger bed that I said, you have to exceed 600 pounds. And then at the very bottom, "A total, electric hospital bed is not covered. The height adjusting feature is a convenience feature. Total electric beds will be denied as not reasonable and necessary."

So this again is coming right from cms.gov. You can print it all and, you know, verify this with any other insurance company you're dealing with. Maybe it's, you know, not Medicare, but again, most people follow those guidelines but check with them and ask these questions when you're trying to find out for a loved one or yourself if you actually can meet the qualifications because so many people go with, "Well, my doctor wrote me an order." I mean, even if you do have that, the prescription's one thing but you've gotta have the documentation to back it up. You're gonna have to show the pulmonary aspiration, you're gonna have to show congestive heart failure, you're gonna have to show all this criteria in documentation, whether it's coming from, you know, rehab, or it's coming from the doctor, home health, wherever it may be.

I hope this is helpful. Because I see a lot of people that just don't understand the coverage criteria. And that's where we can help you out. That way you know for sure, hey, if insurance is covering it, and I hope they do, great. If not, that's where you can reach out to us in All Star Medical here around the Middle Tennessee area. We'll be glad to help you out with any of that stuff. We have a location in Hermitage, we have a location in Franklin. If you wanna order a bed, you can order it online. Rental, we can rent them locally around the Middle Tennessee area. But you wanna purchase one and say you're outta state, you can order it online and we'll ship it directly to you. They're not really hard to put together, they do break down again into pieces.

But I hope this video was helpful maybe explaining some of the details. You can give us a call at 615-730-9438. If there's anything you might have questions about, feel free to call us. You know, repost something or ask us on this video here. We'd be glad to answer your questions or call you and try to help you out with anything we can. Again, hope this is helpful.

This is Kevin with All Star Medical. Y'all have a great day.

  • hospital bed guidelines