Why We Don't Take Insurance — And Why That's Good News for You
A transparent look at why Cleveland HME operates entirely outside Medicare and insurance billing, what that means for the products you can actually access, and how our documentation still puts money back in your pocket.
Why we don't bill insurance
When you walk into Cleveland HME, you won't hear us ask for your Medicare card or insurance information. That's intentional — and it's not a gap in our capabilities. It's a deliberate model built around giving you better equipment, faster service, and honest guidance.
The reality of the DME industry: billing Medicare and insurance for durable medical equipment is one of the most expensive, compliance-intensive operations in healthcare. Accepting insurance requires federal enrollment, CMS accreditation, a surety bond, prior authorization paperwork, compliance audits, and a billing team — overhead that almost always comes at the direct expense of the customer experience.
Medicare and Medicaid reimburse DME suppliers at rates set by the federal government — rates cut repeatedly through competitive bidding programs. For many categories of equipment, reimbursements don't cover the cost of the product, let alone delivery, setup, service, and follow-up. To survive on those margins, large insurance-billing DME companies typically stock only the cheapest products that meet coverage criteria, route customers toward what Medicare approves rather than what's right for them, and require weeks of prior authorization before anything ships.
We built Cleveland HME around the opposite model. By operating entirely outside insurance billing, we carry premium brands, offer same-day availability, provide genuine expert guidance, and stand behind every product — without a stack of authorization forms between you and what you need.
What insurance usually won't cover — even when you expect it to
Even with Medicare, the specific product you want — or need — often isn't covered at all. Medicare operates from a rigid approved equipment list with strict eligibility criteria. Most premium, lightweight, or comfort-oriented products fall entirely outside that list.
More importantly: even when coverage exists, it typically only pays for a basic version of the product, not the one you actually want. The gap between what insurance will fund and what will genuinely serve your daily life is often significant.
Power scooters. Medicare covers scooters only when a physician documents that you cannot operate a manual wheelchair and cannot walk at all. Even then, coverage is limited to the most basic model in the approved category — not portable, foldable, or travel-friendly versions.
Portable and folding power wheelchairs. Lightweight, compact, or carbon fiber power chairs — the kind genuinely useful for independent daily living — almost always fall outside Medicare's definition of medically necessary. Coverage, when it exists, tends to apply to heavier institutional-grade models.
Lift chairs. Medicare Part B covers only the motorized lift mechanism (HCPC code E0627) — not the chair itself. The 2026 Medicare-approved amount for the mechanism is approximately $309. After Medicare pays 80% of that, you receive roughly $247. Everything else — the chair's frame, fabric, cushioning, heat, massage, or reclining features — is entirely your expense. On a $1,800 premium lift chair, that $247 barely touches the cost.
Premium hospital beds. Insurance typically covers basic semi-electric beds for qualifying diagnoses. Low-airloss mattresses, bariatric frames, hi-low full-electric beds, and beds from premium manufacturers are rarely covered or reimbursed at rates suppliers can't accept.
Premium rollators and walkers. Carbon fiber rollators, all-terrain walkers, and lightweight ergonomic designs are almost never covered. Medicare reimburses standard aluminum rollators at a fixed low rate and will not pay more for a $600 byACRE Carbon Ultralight just because it's objectively better for your body.
The products most people want — lighter, more capable, better-designed, genuinely life-improving — are almost exactly the products insurance won't fund. The coverage system was built around clinical minimum standards, not quality of life. We carry the products that close that gap.
Ohio Rx status: your sales tax exemption on qualified equipment
Here's something most customers don't know: in Ohio, durable medical equipment sold with a valid physician's prescription is exempt from sales tax under Ohio Revised Code 5739.02(B)(19).
The law covers prosthetic devices, durable medical equipment for home use, and mobility-enhancing equipment — when purchased pursuant to a prescription for use by a human being. For most of the equipment we carry, this applies.
Ohio's combined state and county sales tax typically runs between 6.75% and 8% depending on jurisdiction. On a $3,000 power wheelchair, that's $200–$240 back in your pocket — automatically, at the point of sale.
To qualify, you need a valid signed prescription from your physician, physician assistant, or nurse practitioner documenting the medical need for the category of equipment. The prescription doesn't need to name a specific model — it should identify the type of device and the underlying condition or need it addresses.
We keep the prescription on file, complete the required Ohio exemption certificate with you, and apply the tax break at the register. The savings are immediate — no rebate to wait for, no forms to mail later.
Not sure if your situation qualifies? Call us before you come in and we'll tell you exactly what to bring.
Questions? Call us at (216) 400-5885 — we'll tell you quickly what to bring.
What is an HCPC code?
Every receipt from Cleveland HME includes a code that looks something like K0800 or E0627. This is your HCPC code, and it's more valuable than it looks.
HCPC stands for Healthcare Common Procedure Coding System — a standardized classification developed by the Centers for Medicare & Medicaid Services (CMS) to identify medical products, services, and equipment for billing and documentation. It's the universal product language of healthcare reimbursement.
When a doctor writes a prescription, when an insurance plan processes a claim, when an HSA administrator reviews a receipt, or when Medicare evaluates documentation — the HCPC code is how they verify exactly what product was prescribed and provided.
We include the correct HCPC code on every receipt. Even though we don't bill insurance directly, that code is what makes your purchase documentation usable for HSA/FSA reimbursement, private insurance out-of-network claims, and tax purposes.
What's on our receipt — and why every field matters
Every Cleveland HME receipt is structured to function as a complete documentation package — not just a proof of purchase. We include the specific fields that private insurance plans, HSA/FSA administrators, secondary insurers, and tax records require.
How to seek reimbursement after purchase
This is the most important section to read carefully — because the path to reimbursement is very different depending on what type of coverage you have. We want to set honest expectations rather than raise hopes that may not be met.
Medicare will almost certainly not reimburse you for purchases made at Cleveland HME. Here's why: Medicare requires that a DME supplier be actively enrolled as a DMEPOS supplier — with CMS accreditation, a PTAN, a surety bond, and PECOS enrollment — before it will pay for any equipment from that supplier. Cleveland HME is a private-pay retailer and is not enrolled in Medicare as a DMEPOS supplier.
You are welcome to submit form CMS-1490S to Medicare using your receipt from us, and in rare circumstances Medicare may review such claims. However, you should expect a denial. We tell you this because it's the truth — we'd rather you have accurate expectations than be disappointed after the fact.
If Medicare coverage of a specific product is critical to your budget, we recommend working with an enrolled Medicare DME supplier for that item and coming to us for everything else.
Many private insurance plans (employer plans, BCBS, Aetna, UnitedHealth, and others) allow members to submit out-of-network DME claims directly. This is separate from Medicare and has a much more realistic chance of resulting in at least partial reimbursement.
Call the member services number on the back of your insurance card and ask: "Does my plan cover out-of-network durable medical equipment? What documentation do I need to submit a member claim?" Every plan is different — get the answer and the claim submission address in writing.
Your receipt from us — with the HCPC code, EIN, product description, and date of service — is the core document they'll need. Some plans will also require a physician's prescription and a completed claim form from the insurer.
If you have a Health Savings Account or Flexible Spending Account, most durable medical equipment qualifies for reimbursement automatically. The process is usually as simple as logging into your HSA/FSA administrator's portal, uploading a photo of your receipt, and submitting.
Our itemized receipts include your HCPC code and EIN — which is typically all your administrator needs. Many platforms let you do this from a phone in under two minutes. There's no insurance company to negotiate with and no prior authorization required.
If you have an HSA or FSA, this is your clearest and most reliable reimbursement path.
Secondary insurance policies — including many Medigap plans — generally follow Medicare's lead. If Medicare won't cover the primary claim, a supplemental plan typically won't cover the remainder either. However, some standalone supplemental plans or employer secondary policies have their own DME benefits. Check your plan documents or call member services to ask specifically about out-of-network DME purchases.
Our team is glad to explain your receipt, help you understand any field on it, or produce supplemental documentation your plan needs. We can't file claims on your behalf, but we'll give you everything you need to do it yourself. Come in or call us at (216) 400-5885.
Frequently asked questions
Real questions we hear from customers every week — answered honestly.
Almost certainly not. Medicare requires the supplier to be enrolled as a certified DMEPOS provider. Because Cleveland HME is a private-pay retailer, Medicare will deny claims for equipment purchased here in almost all circumstances, even if you submit them yourself using form CMS-1490S.
You can still try — CMS-1490S is publicly available at medicare.gov and you can mail it with your receipt to your Medicare Administrative Contractor. But be prepared for a denial. If Medicare coverage is a financial necessity for a specific item, get that item from an enrolled supplier and shop with us for everything else.
Medicare Advantage (Part C) plans are administered by private insurers but generally apply the same supplier enrollment requirements as Original Medicare. Most Advantage plans will deny claims from non-enrolled suppliers like Cleveland HME.
That said, some Advantage plans have supplemental benefits with more flexible out-of-network provisions. It's worth calling member services to ask specifically — the answer can vary by plan.
Private commercial insurance often has out-of-network DME benefits that work differently from Medicare. Here's what to do:
- Call member services and ask if your plan covers out-of-network DME.
- Ask what their reimbursement rate is (e.g., 70% of allowed amount after deductible).
- Ask what documentation they require — usually a receipt with HCPC code, EIN, and a physician prescription.
- Get their member claim submission address or portal link in writing.
- Submit your receipt from us along with any claim form they require.
This path has a real chance of working depending on your plan.
Yes — and this is usually the easiest path. Most durable medical equipment qualifies as an HSA/FSA-eligible expense under IRS guidelines. You can pay directly with your HSA debit card at the register, or pay out of pocket and submit your itemized receipt to your administrator for reimbursement.
Our receipts include your HCPC code and EIN, which is all most administrators require. Many HSA portals let you upload a receipt photo and get reimbursed in minutes. No prior authorization, no insurance negotiation, no denial letters.
Yes — and it's one of the main reasons customers come to us. Insurance coverage is built around clinical minimums. It will pay for a product that meets a basic functional threshold, not necessarily the one your therapist, physician, or ATP recommended as the best fit for your body and lifestyle.
At Cleveland HME, you choose based on fit, function, and quality — not on what a coverage grid allows. Our team includes an ATP-credentialed clinician who can help match you to the right product without insurance dictating the options.
No. As a private-pay retailer, we don't require a prescription to purchase most equipment. You can walk in, choose the product that fits your needs, and walk out same day.
However, if you have a physician's prescription, bring it — it qualifies you for Ohio's sales tax exemption on DME, which saves you 6.75–8% on your purchase. It also makes your receipt more useful for insurance or HSA submissions.
Medicare and most insurance companies use a legal standard called "medical necessity" to determine whether they'll pay for a product. It means more than your doctor thinks it would help. It means the equipment must meet a specific clinical threshold — typically backed by an ICD-10 diagnosis code, documented functional limitations, and evidence that less expensive alternatives have been tried and failed.
For power wheelchairs, Medicare requires documentation that you cannot propel a manual wheelchair and cannot walk at all — not just that walking is difficult. For lift chairs, you need documentation of a severe, irreversible condition affecting your ability to transition from seated to standing. Many denials happen not because the product is wrong, but because the clinical documentation didn't use the right language. If you're pursuing an insurance claim, working closely with your physician on prescription language is critical.
A Letter of Medical Necessity (LMN) must come from a licensed physician or qualified healthcare practitioner who has evaluated you — insurance companies will not accept an LMN from a DME retailer.
What we can do: provide a detailed product specification letter on our letterhead describing the clinical appropriateness of the equipment category. Your physician can use this as a reference when writing the LMN for your claim.
Physicians are often well-intentioned but sometimes don't know the specifics of DME coverage criteria. A doctor saying "Medicare should cover this" usually means the product seems clinically appropriate — not that it actually meets the coverage criteria for your specific situation.
If Medicare coverage is important for your purchase, ask your doctor to document the specific ICD-10 diagnosis, your functional limitations, and why lesser alternatives are insufficient. Then work with an enrolled Medicare DME supplier who can submit the claim properly. For purchases at Cleveland HME, the Medicare coverage determination will rest with the insurer — not with us or your doctor's verbal guidance.
Under Ohio Revised Code 5739.02(B)(19), durable medical equipment for home use and mobility-enhancing equipment sold pursuant to a prescription are exempt from Ohio sales tax. This applies to most of the mobility and medical equipment we carry.
To claim the exemption, bring a valid signed prescription from your physician, PA, or NP documenting the medical need. We'll apply the exemption at the register and complete the required Ohio exemption certificate with you. The savings are immediate — no forms to mail, no rebate to wait for.
Yes — for both Medicare and private insurance, you have the right to appeal a denial. For Medicare, there are five levels: Redetermination → Reconsideration → ALJ Hearing → Medicare Appeals Council → Federal Court. Your denial letter will include appeal instructions and deadlines (typically 120 days from the denial date).
For private insurance, your denial letter should include the specific reason, the appeal process, and a deadline. Most plans allow at least one internal appeal and may offer independent external review after that.
Keep in mind: for purchases from Cleveland HME, a Medicare appeal based on supplier non-enrollment is very unlikely to succeed. Appeals work best when the denial was based on documentation deficiency or medical necessity criteria that can be supplemented with additional evidence.
Yes — we have financing options available for qualified customers. Ask us in store or call (216) 400-5885 for current terms. We also offer rental arrangements for certain equipment categories, which lets you use a product before committing to a full purchase.
Not always — and often not by as much as people expect. Insurance coverage has real costs: premiums, deductibles, coinsurance, prior authorization delays, and being locked into a lower-quality product that insurance will approve. For many common purchases, the out-of-pocket cost at Cleveland HME is comparable to — or lower than — the total cost of the insurance route, especially after factoring in the Ohio tax exemption and HSA/FSA reimbursement.
Where insurance matters most is for very high-cost items — complex rehab power wheelchairs or specialized equipment costing $10,000 or more. For those, working with an enrolled Medicare supplier is often the right financial decision. For the everyday mobility equipment most of our customers need, the private-pay route often makes more practical and financial sense than it first appears.
Still have questions? We're easy to reach.
Whether you're working through coverage questions, comparing products, or just want honest advice — our team is glad to help.
