Does Blue Cross Blue Shield of Texas Cover Durable Medical Equipment?

Blue Cross and Blue Shield of Texas plans may provide benefits for durable medical equipment, but coverage is not the same for every member or every piece of equipment.

The patient’s specific plan, eligibility, medical necessity, network requirements and applicable authorization rules can all affect coverage.

What Types of DME May Be Considered?

Depending on the member’s benefits and medical needs, durable medical equipment can include items such as:

• Wheelchairs

• Walkers

• Rollators

• Hospital beds

• Mobility equipment

• Other medically necessary home equipment

Coverage for a particular item should always be verified before assuming that it will be paid by the plan.

Why Benefits Should Be Verified First

BCBSTX advises providers to verify eligibility and benefits before providing services.

This can help identify:

• Whether coverage is active

• Applicable DME benefits

• Network requirements

• Deductible

• Coinsurance or copayment

• Prior-authorization requirements

• Utilization-management requirements

However, verification of benefits or obtaining prior authorization does not guarantee payment. Final benefits are determined when the claim is processed according to the member’s coverage.

Is Prior Authorization Always Required?

Not necessarily.

Prior-authorization requirements can vary by plan, member and service, and BCBSTX periodically updates its requirements.

That’s why the current requirements for the individual member and equipment should be checked instead of relying on a general assumption.

Medical Necessity Still Matters

Having a DME benefit doesn’t necessarily mean every piece of equipment is covered.

The requested equipment may need to satisfy the plan’s medical-necessity requirements and applicable medical policies.

Supporting documentation from the treating healthcare provider may therefore be necessary.

What Will the Patient Pay?

Patient responsibility depends on the individual plan.

Possible costs can include:

• Deductible

• Coinsurance

• Copayment

• Noncovered equipment or upgrades

The amount can vary significantly between plans, even when both patients carry a Blue Cross and Blue Shield of Texas card.

BCBSTX DME Provider in San Antonio

Vital Doctors Medical Equipment works with BCBSTX patients in the San Antonio area.

Our team can help verify available benefits and explain the DME process before equipment is provided.

Patients should have their current insurance information available so eligibility and benefits can be checked for the specific equipment requested.

Benefit verification and authorization are not guarantees of payment. Coverage is determined by the member’s eligibility, plan terms, medical necessity and applicable payer requirements.