Prosthetics, Orthotics, Diabetic and Medical Supplies
Does Not Apply to CDHP Members
DMEnsion Benefit Management, a licensed third party administrator, provides DME, prosthetics, orthotics and medical supply services to PEBTF Members.
- DME includes equipment such as wheelchairs, oxygen, hospital beds, walkers, crutches and braces, etc.
- Prosthetics and Orthotics (P&O) include artificial limbs, braces (such as leg and back braces), breast prostheses and medically-necessary shoe inserts for diabetics
- Medical supplies includes urological and ostomy supplies
- Diabetic supplies include syringes, needles, lancets, test strips, pumps and glucometers (Members should obtain insulin under the Prescription Drug Plan)
Members have both a Network and a Non-Network benefit. If you elect to choose a Network Provider, you are eligible to receive covered benefits at no cost. To find a Network Provider, contact DMEnsion Benefit Management at 1-888-732-6161 or log on to their web site at www.dmension.net. The Network is extensive and it includes most major DME/P&O Providers.
Pre-certification is required for the rental of any DME item and the purchase of all DME and P&O devices.
If you use a Non-Network Provider, you will be responsible for 30 percent of the allowable amount plus the difference between the actual amount billed by the Provider and the DMEnsion Benefit Management allowed amount.
The Plan follows Medicare guidelines for the coverage of DME, prosthetics, orthotics, medical supplies and diabetic supplies. These nationally-recognized standards are used by many insurance companies throughout the country. Most Providers and medical facilities are familiar with these guidelines.
NOTE: Equipment or supplies dispensed in a physician’s office or emergency room setting, provided as part of Home Health Care, Skilled Nursing Facility care or Hospice services; or as part of covered dialysis and home dialysis will continue to be paid by your medical plan, provided it is billed by the Provider and not by a DME supplier, and will not be subject to the DMEnsion Benefit Management Program. Your Provider may dispense the equipment and will bill your medical plan. For example, if you receive a knee brace or crutches at the emergency room, it will be billed to your medical plan, if it is billed by the facility and not a separate DME Provider. If your doctor writes a prescription for a DME item, you should obtain it from a DMEnsion Network Provider in order to get the highest level of benefits.
For more information, refer to your Summary Plan Description or contact PEBTF.
To contact DMEnsion: 1-888-732-6161 www.dmension.net