5 Reasons Cleveland HME Doesn't Work With Insurance
This isn't a workaround or a limitation — it's a choice. Here's the honest, inside-the-industry explanation for why we built our business entirely outside the insurance billing system, and what that means for you.
We get asked this question almost every day: "Do you take insurance?" And when the answer is no, the follow-up is usually: "Why not?"
It's a fair question. Most people assume that not accepting insurance is either a gap — something we haven't gotten around to yet — or a red flag. It's neither. Our team has a combined 60+ years in the home medical equipment industry. We've seen how the insurance billing side of this business works up close, and we made a deliberate choice to build something different.
Here are the five real reasons why.
Reimbursement rates make delivering good service financially impossible
The economics of Medicare DME billing have been systematically dismantled over the past 15 years. Beginning in 2011, CMS implemented a competitive bidding program (DMEPOS Competitive Bidding) that dramatically cut reimbursement rates across every major product category — power wheelchairs, rollators, hospital beds, scooters, oxygen, and more.
The idea behind competitive bidding was to reduce government spending by forcing suppliers to undercut each other on price. It worked — in the sense that reimbursements dropped, in some categories by 40–60%. What it also did was make it structurally impossible for a DME supplier to deliver quality equipment and service at the rates Medicare would pay.
When a Medicare-enrolled supplier gets paid $1,500 for a power wheelchair that costs $3,000 wholesale — and then must also handle delivery, fitting, warranty service, and documentation — the math simply doesn't work unless you cut corners somewhere. Most insurance-billing DME companies cut corners on product quality, staffing, or both.
A customer calls a large insurance-billing DME company asking about a power wheelchair. The sales rep isn't asking what's best for the customer — they're asking what Medicare will approve at a reimbursement rate the company can survive on. The product recommended is often the cheapest item that clears the coverage threshold, not the one that fits the person's actual needs or lifestyle.
At Cleveland HME, we price products to be competitive with what you'd pay out of pocket anywhere. No reimbursement calculation. No cutting corners to make the math work.
Prior authorization is a product filter, not a quality filter
Prior authorization is the process by which a Medicare-enrolled DME supplier submits clinical documentation to Medicare — or a private insurer — before providing equipment. It's often described as a way to ensure appropriate care. That's partially true. But it also functions as something else entirely: a mechanism that filters customers toward cheaper products and away from better ones.
Here's how it actually works: Medicare's coverage criteria for most DME categories define a functional minimum. To qualify for a power wheelchair, for example, your physician must document that you cannot propel a manual wheelchair and cannot walk at all. If you meet that threshold, Medicare will cover a power wheelchair — but specifically a basic, standard model within the approved reimbursement tier.
Imagine your physical therapist recommends a lightweight folding power chair — something you can actually lift into a car, use at appointments, and manage independently. That product likely doesn't exist within Medicare's approved reimbursement tiers. So the supplier has two choices: submit for the approved product (a heavier, harder to manage chair that fits the coverage criteria) or tell you that what your PT recommended isn't covered.
The prior authorization system didn't evaluate whether the lightweight chair was better for you. It evaluated whether it fits an approved billing code at a reimbursable rate. Those are completely different questions.
Prior authorization also takes time — typically three to six weeks for power mobility equipment when you factor in physician documentation, submission, and insurer review. During that window, you're waiting. We can have you in the right chair the same day.
"The product insurance approves and the product that's right for you are often not the same thing. Our job is to find you the second one."
Insurance compliance costs are enormous — and they come straight out of your experience
Operating as a Medicare-enrolled DMEPOS supplier isn't just a matter of billing. It requires a substantial and ongoing compliance infrastructure that has nothing to do with actually helping customers.
- CMS accreditation through an approved accreditation organization (ACHC or The Joint Commission) — a multi-year, multi-thousand-dollar process with on-site surveys
- A surety bond ($50,000 minimum for most suppliers)
- PECOS enrollment and an active PTAN (Provider Transaction Access Number)
- Dedicated billing staff trained in HCPC coding, modifier use, ABN forms, and claim submission
- Audit readiness — Medicare conducts post-payment audits (RAC, CERT, ADR) that can claw back payments years after the fact, requiring extensive documentation retention
- Written policies and procedures for every aspect of operations, from intake to delivery to complaint handling
- Annual re-accreditation and ongoing compliance monitoring
A small to mid-sized DME company can easily spend $150,000–$300,000 per year on compliance overhead before a single product leaves the floor. That cost has to be recovered somewhere. In practice, it gets recovered by reducing investment in people, in product selection, and in customer-facing service quality.
We put that money into our showroom, our team, and our inventory instead. John, our co-owner and ATP, has 45 years of experience in this industry. Max, our repair tech, is certified on Pride, Golden, Quantum, and Invacare. Those are the choices a private-pay model makes possible.
- Carry premium brands across every category — byACRE, Pride, Golden, Invacare, Med-Mizer, and more
- Staff experts with real industry credentials, not call center agents reading from scripts
- Offer same-day fulfillment on most in-stock products
- Provide in-house repair with a certified technician on-site
- Maintain a true showroom where you can try products before you buy
Insurance locks suppliers into approved product lists — not the best products
To bill Medicare for a product, that product must have an appropriate HCPC code and must fall within the coverage criteria for that code. Products that don't fit neatly into billing codes — or that exist in a category Medicare doesn't cover — simply can't be sold through an insurance billing pathway. So insurance-billing DME suppliers don't carry them.
This creates a massive blind spot in what most DME stores even stock. The most exciting, most effective, most genuinely life-improving products in the mobility and home medical equipment space are almost entirely absent from insurance-billing suppliers because there's no billing code to support them.
| Product category | Typical insurance-billing stock | What we carry |
|---|---|---|
| Rollators | Basic aluminum, standard weight, approved HCPC only | byACRE Carbon Ultralight, Carbon Overland, Nordic Pioneer — full carbon fiber lineup |
| Power wheelchairs | Standard group 1–2 models within reimbursable tiers | Portable folding chairs, travel models, advanced rehab seating, premium compact designs |
| Lift chairs | Basic 2-position or 3-position models that qualify for E0627 | Full recline, heat & massage, zero gravity, infinite position — Golden and Pride full lines |
| Hospital beds | Semi-electric models meeting minimum coverage criteria | Hi-low full electric, low-airloss, bariatric, Med-Mizer premium, adjustable bases |
| Scooters | Group 1 standard scooters approved under K0800 | 3-wheel, 4-wheel, heavy duty, all-terrain, travel-folding, full Pride and Golden lineups |
The products in the right column exist. They're available. People want them. Insurance-billing suppliers just can't profitably sell them, so they don't. We can, and we do.
As mobility technology improves — lighter materials, better batteries, smarter controls, more ergonomic designs — the gap between what's available on the market and what insurance will pay for keeps growing. The best carbon fiber rollator today weighs 13 pounds and folds in seconds. Medicare's approved rollator is a basic aluminum frame. Both are called "rollators." Only one of them is worth using every day.
Insurance incentives and your best outcome are fundamentally misaligned
This is the one that rarely gets said out loud, so we'll say it plainly: an insurance company's financial interest is to pay as little as possible for your equipment. That's not a criticism — it's simply how the system works. Insurers manage risk pools and control costs. Paying for the best rollator when they can pay for a basic one costs more money.
An enrolled DME supplier's financial interest is to sell you whatever product generates the most reimbursement relative to its cost — not the product that's best for you. When reimbursements are compressed, that means selling the cheapest qualifying product as efficiently as possible.
Your interest is to get the product that best supports your independence, safety, and quality of life. In the insurance billing system, that interest comes third.
When you buy from Cleveland HME, our only financial interest is in selling you something you're happy with — because our business runs on reputation, referrals, and repeat customers in a tight-knit community. A customer who gets the wrong product doesn't come back, doesn't tell their friends, and doesn't send us referrals from their physician or physical therapist.
We have John — an ATP with 45 years in this industry — on the floor to help you find the right product. Not the cheapest product that meets a coverage threshold. The right one. That's a fundamentally different conversation, and it's only possible because we're not constrained by what an insurer will reimburse.
"We've been doing this long enough to know what premium DME looks & feels like. And premium products dont usually come from an approved billing code list."
The bottom line
The insurance billing system for durable medical equipment was designed to control government spending — not to optimize your outcome. After 15 years of competitive bidding, rate cuts, accreditation requirements, and audit exposure, the DME suppliers who stayed in the system are operating on razor-thin margins with limited product selection and stretched service teams.
We chose a different path. Private-pay means we carry what's actually good. It means we can tell you honestly what will work for your life. It means you leave our showroom with the right product the same day, without waiting weeks for an authorization that might not come through anyway.
It also doesn't mean you're on your own with costs. Our receipts include everything you need for HSA/FSA reimbursement, private insurance out-of-network claims, and the Ohio sales tax exemption if you have a physician's prescription. We've built the documentation to support you — we've just removed the insurance company from the middle of the transaction.
Come see the difference in person.
Our showroom is open and our team is here. No appointment needed, no authorization required.
