Are you a Bay Area resident with a medical condition requiring durable medical equipment (DME)? You may be wondering what types of equipment are covered by San Francisco Health Plan. We get it — DME can be expensive, making it difficult for many people to access the care they need.  

Our experienced complex rehab experts explain what durable medical equipment San Francisco Health Plan covers, including eligibility requirements and how to navigate the process here. 

What Is San Francisco Health Plan?

San Francisco Health Plan is a public, not-for-profit, NCQA Accredited Medicaid HMO Health Plan that has been doing great things since 1994. They're all about managed care health services and improving health outcomes for low-income San Francisco residents through partnerships with the city's public and community-minded doctors, clinics, and hospitals. 

SFHP has everything you need, from preventive and specialty care to hospitalization, prescription drugs, and family planning services. With over 145,000 members, they're the clear choice in San Francisco! But they're not just about the numbers. 

SFHP also provides third-party administrative services to the Healthy San Francisco and City Option programs, showing they're committed to universal coverage and ensuring everybody can access high-quality health care.

What Is Durable Medical Equipment?

Durable medical equipment, or DME for short, is a range of medical gear your doctor prescribes to help you manage a chronic condition or recover from an injury or illness. It’s built to last and be used over the long term, unlike disposable medical supplies you use once and toss.

Think of wheelchairs, hospital beds, oxygen equipment, and walkers — that's the gear we're talking about here. And the cool thing is, if your doctor says you need it, DME is usually covered by your health insurance, including Medicare and Medicaid.

Types of DME San Francisco Health Plan Covers 

1. Mobility Aids

Mobility aids are devices designed to assist individuals with qualifying diagnoses or mobility impairments in their daily activities. These aids can be as simple as a walking cane or as complex as a power wheelchair.

Power wheelchairs, in particular, are highly advanced mobility aids that can provide independent mobility to individuals with a wide range of disabilities. They have revolutionized the mobility of individuals with disabilities, enabling them to move independently and participate in everyday activities. 

2. Hospital Beds

San Francisco Health Plan covers hospital beds and other home healthcare equipment. Adjustable beds are designed for use in hospitals, clinics, or other medical facilities to provide comfortable and safe accommodations for those who are bedridden or have limited mobility due to a health condition. 

SFHP also offers coverage for medical supplies such as bandages, catheters, and syringes. 

3. Oxygen Equipment

Oxygen equipment, including concentrators and portable tanks, can help deliver oxygen to individuals with respiratory issues, such as chronic obstructive pulmonary disease (COPD) or sleep apnea. 

San Francisco Health Plan provides coverage for nebulizers commonly prescribed to those with asthma, cystic fibrosis, and other respiratory conditions. 

4. Diabetic Supplies

The program covers blood glucose monitors and diabetic supplies. These devices are essential for those who regularly check their blood sugar levels to manage their condition effectively. 

5. Prosthetic and Orthotics

Prosthetic and orthotic devices replace or support body parts that have been damaged or lost due to injury, illness, or congenital conditions.  

San Francisco Health Plan will also cover cervical collars, which immobilize the neck and provide support to individuals who have suffered a neck injury or have a neck condition that requires immobilization. 

How to Get DME Covered by San Francisco Health Plan

Many health insurance plans typically cover DME if the equipment is deemed medically necessary and meets specific criteria. To get Durable Medical Equipment (DME) covered by San Francisco Health Plan in Northern California, you should follow these steps:

  • Check Your Plan Benefits - The first step is to review your plan benefits to determine if your health insurance covers Durable Medical Equipment (DME). You can obtain this information by referring to your member handbook or contacting the customer service number on your insurance card.

  • Get a Prescription - For DME, it is necessary to have a prescription from your physician. Ensure that the prescription specifies the exact item(s) required, the duration it should be used, and any other pertinent details.

  • Choose a DME Supplier - San Francisco Health Plan provides a list of authorized DME suppliers. It is recommended you select a supplier from this list to ensure that your insurance covers the cost of the equipment.

  • Obtain Prior Authorization - Prior authorization from the San Francisco Health Plan is required before receiving DME. Your doctor must provide documentation to the insurance company showing the equipment's necessity and how it could benefit your health.

  • Follow Up With Your Supplier - Once you have obtained prior authorization, you can work with your chosen DME supplier to place an order and receive the necessary equipment. Following up with the supplier is advisable to ensure that everything is in order and that your insurance covers the DME.

Get the DME You Need: Contact Us Today!

If you or someone you know needs a wheelchair or any other mobility aid, Freedom Mobility is a leading provider of durable medical equipment in Northern California. 

From San Francisco to San Jose, Clearlake to Sacramento, our experienced professionals are dedicated to providing you with the best possible care and service. Contact us today to learn more about our selection of high-quality wheelchairs and other DME products.