Medicare Approved Back Braces

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Medicare Approved Back Braces

Pain relieving back braces fall into the category of DME (Durable Medical Equipment). They are covered by Medicare Part B under the prefabricated orthotics benefit.

If you are suffering from pain in your back, neck, shoulders, ankles, or wrists and have Medicare you probably can get braces with little or no out of pocket. In many cases if you have PPO insurance you likely qualify for braces with little or no out of pocket as well.

Does Medicare Approve Other Types of Braces? (neck, shoulder, ankle, elbow, knee, and wrist)

Pain relieving braces are covered by Medicare if they are determined by a physician to be medically necessary. You need a prescription from a doctor in order to get support or post-surgical braces covered by your Medicare. Support braces are usually sold by a durable medical equipment supplier or through a physician’s office but you have other options too.

You can order Medicare approved back, neck, shoulder, ankle, and wrist braces by phone, online, or in person.

Your doctor can write you a prescription or your durable medical supplier can request your prescription from your doctor.

There is another option available to you that has been growing in popularity recently. That is the much more convenient services of a teledoc to issue your prescription.

Medicare Back Braces Through Your Physician vs. a Durable Medical Supplier

There are a few pros and cons to ordering your braces through your primary care physician vs. ordering them from a durable medical equipment supplier. First, if you are in pain, you may have trouble physically getting to the doctor’s office. The time it takes to schedule an appointment could be 4-6 weeks depending on the availability of your doctor or the specialist, and so you might have to wait a long time to get help.

Depending on your mobility, you may have trouble finding a ride to your physician’s office, or have pain issues that prevent you from being able to sit in a car comfortably. You may find it very uncomfortable to sit in the waiting room at your physician’s office. Limitations like these can add up to more pain for you so it’s essential you know your options to get the care you need faster and most affordably.

Getting your medical braces through a durable medical equipment company

One of the reasons why ordering braces from a durable medical supply company (by phone) is beneficial, is that they are able to connect you with a teledoc who can consult with you about your pain. He or she then decides if the braces are medically necessary and can subsequently write you a prescription. That prescription will be sent to the DME supplier and used to order your braces.

Once your braces are ordered they can be shipped directly to your home. This avoids you having to suffer any needless pain from physical movements you may be currently unable to perform.

Getting your medical braces through your physician

If you don’t have mobility issues that prevent you from seeing a doctor (the process could take more than a single visit), and you don’t mind waiting for your braces, then you may prefer to go to your physician to request braces.

If you are concerned about the braces fitting just right, keep in mind the braces are usually fully adjustable within a range of sizes so it is unlikely you will have issues with the fit.

You can also get a prescription from your doctor and then order your medical braces through a durable medical supplier by phone or online. The medical supply company can request the prescription from your doctor or you can fax it over to them yourself.

Are Medicare Approved Braces a Scam?

While most durable medical equipment suppliers are legitimate companies providing a valuable service to people who are suffering from acute and chronic pain, like any business, there are bad guys. Recently, for example, a CEO of a multi-million dollar telemedicine company pled guilty to defrauding Medicare and receiving kickbacks from DME companies for issuing braces that were not medically necessary. The telemedicine doctors are meant to assist patients with disabilities and limited mobility, however in this case, the doctors were conspiring with the DME companies to defraud Medicare. Source

Some of the scams involve a pretend company using the Medicare approved braces as an excuse to obtain your social security number. The way it works is this: To order braces, a medical supply company needs to check a person’s Medicare benefits. Until very recently Medicare IDs were a letter or two, followed by the person’s social security number.

This means that any health care provider who has your Medicare ID number also has your social security number. A fake company can talk a lot of people into giving them their social security number this way.

This is an unfortunate security vulnerability. Good news! Medicare IDs are being re-issued. Many seniors have already been sent their new Medicare IDs. For those seniors who have not yet received their new IDs, the process of issuing new numbers should be completed by April 2019.

If your ID still includes your social security number, don’t let that stop you from ordering your Medicare covered back brace, shoulder brace, neck brace, ankle brace, wrist brace, knee brace, or elbow brace through a DME (durable medical equipment) supplier by phone. It is a convenient way to get your braces, especially when you are in pain and have limited mobility or a disability.

Shopping for your braces by phone may be most cost effective. You may have little or no out of pocket cost if your braces are covered by your insurance. You won’t have to spend money on gas or parking to go to the doctor’s office.

Limitations on the Frequency of Ordering Braces Through Medicare

Insurance companies limit the frequency of how often you can order support braces. The limitation is usually once every 5 years per brace. It’s unlikely that you will order braces of such poor quality that they won’t last five years because usually they’re made of pretty durable material. Think neoprene and nylon type materials, for example.

The limitation is in place partly to help prevent fraud. If you could order, say, a Medicare covered back brace every month, you could probably just keep ordering them to sell and turn a profit.

Shipping and returns of Medical Braces

Most suppliers ship the braces to you via UPS or similar and can often provide you with tracking information of your shipment. This may help you to make sure you have someone available to help you fetch the package from your door if necessary, depending on the level of pain you’re in.

If you have any issues with sizing or defects in your new braces, you should be able to contact customer service to have the issue rectified.

Durable Medical Braces Prescription

When ordering medical braces from a durable medical supply company, they will need a prescription from a doctor. You can provide them with your doctor’s prescription or you can use a teledoc. A teledoc is essentially a physician who is available by telephone to assess and assist with your medical issues.

Many health insurance plans include telemedicine as a benefit now because many conditions are easily diagnosed over the phone.

Calling the teledoctor instead of going to a doctor’s office allows members to speak to a physician without leaving the comfort of their home. You can talk to a doctor usually within just 30 minutes to 48 hours, depending on the service, without having to book an appointment weeks in advance, and without having to leave the comfort of their home. This also saves you from sitting in a waiting room with sick patients, putting you at risk.

Medicare Approved Braces via Teledoc

The teledoctor discusses your pain levels with you and asks you questions to determine if the braces are medically necessary. If the doctor concludes you can benefit from the braces, he or she will issue you a prescription. The doctor’s office will forward the prescription to the DME supplier.

Assuming your DME supplier received your prescription, your medical braces will be sent to you by mail.

The DME company can also request a prescription from either your primary care doctor or your teledoc on your behalf. In either case, the DME supplier usually handles all the paperwork for you.

Why Order Back, Neck, Shoulder, Ankle, and/or Wrist Braces?

Most people feel the need to be stoic when it comes to back pain or other pain in the joints or muscles. They often feel it’s just part of growing older and they don’t want to sound like they are complaining too much. They only think to do anything about it when the pain has become too unbearable to ignore anymore. The trouble with thinking like this is that by the time the pain is unbearable, it actually becomes harder for the affected area to heal quickly.

Neglecting a painful area of your body for too long can result in permanent damage. Consequently, the damage may require more intensive therapy in addition to braces. You, your friends, and family will be much happier knowing you are taking responsible measures to avoid needless suffering. It’s best to listen to your body and do what you can to get relief as soon as possible. Having less pain will have a huge, positive impact on your life.

If you have any of the following conditions you can likely benefit from a pain relieving brace

  • Lower Back Pain
  • Upper Back Pain
  • Neck Pain
  • Shoulder Pain
  • Ankle Pain
  • Wrist Pain or Numbness
  • Fibromyalgia
  • Herniated Discs
  • Back Surgery Recovery
  • Osteoarthritis
  • Spondylosis
  • Post-operative support
  • Spinal stenosis
  • Post laminectomy syndrome
  • Decompressive procedures
  • Degenerative, herniated or bulging discs
  • Chronic Muscle or Joint Pain
  • Sprains / strains
  • Spondylolisthesis
  • Lumbosacral Orthosis

How do medical support braces relieve pain?

Studies show that support braces relieve pain and assist in healing better than physical therapy alone. Medical braces accomplish pain relief via the ergonomic support they provide. For example, back braces:

  • Reduce muscle tension and low back pain
  • Improve posture and help to distribute weight evenly on the spine
  • Provide a good support for for spinal structures during healing
  • Increase movement and mobility function during the performance of daily activities

Good support braces should do these 4 things

The ergonomic designs of braces vary, however the basic goals of a brace is to accomplish the following:

  • Improve and Increase Support. A brace can add stability to a body part that is unstable due to injury or weakness. For instance, a back brace supports posture because it helps hold the torso in a position that allows healing.
  • Minimize Range of Motion to Assist Healing. By design, medical support braces eliminate and minimize range of motion, such as turning too much in any direction or bending forward too sharply. Because the brace limits painful movements, it allows those areas to heal. By correcting and applying proper positioning physical postures can improve body awareness of its positioning, aka proprioception. Because of this you will improve your ergonomics long term even when you aren’t wearing a brace.
  • Minimize Micro-Motion Between Vertebrae. Back braces will reduce micro-movements of vertebrae which may be over stimulated, inflamed, or have irritated joints or nerve roots. Limiting the micro movements helps by reducing this irritation, allowing the segments to heal.
  • Minimize Pressure. A brace can help unload some of the weight normally placed on an area. A back brace lessens painful muscle tension by reducing spinal pressure.

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