Caregiver guide
Claim denied — or the payments just stopped?Usually, it’s a rule, not a mistake.
Two moments rattle families. A denial letter arrives for equipment a patient clearly needs. Or the monthly insurance payments for a rental simply stop. Most of the time, neither is an error: Medicare pays for most equipment rentals for 13 months, and oxygen for 36, and then the coverage changes by design. This guide explains the rules, the common denial reasons, and what to do next.
The 13-month rule
Most rentals: paid for 13 months, then yours.
Most durable medical equipment — hospital beds, wheelchairs, patient lifts — rents under what Medicare calls a capped rental. The plan pays a monthly rental for 13 months of continuous use. At the end of month 13, ownership of the equipment transfers to the patient, and the rental payments stop. After ownership, Medicare may help with maintenance and servicing. If the payments for a hospital bed or wheelchair stopped at month 13, that is almost certainly what happened.
The 36-month rule
Oxygen: 36 months of payments, 5 years of equipment.
Oxygen runs on a longer clock. Medicare pays the oxygen rental for 36 months. After month 36, the supplier must keep providing the equipment — and maintaining it — for the rest of its 5-year reasonable useful lifetime, without monthly rental payments. Only after the 5 years can replacement equipment start a new payment cycle. This is why a supplier cannot simply bill a new rental when the old one is capped out — and why a denial that mentions the cap is usually final on that equipment.
Denials
Why claims get denied.
- Paperwork gaps — the prescription or the doctor’s notes do not fully document medical necessity
- The cap was reached — the 13-month or 36-month limit on that equipment has run out
- Same or similar equipment — the plan already paid for an equivalent item
- The plan changed — a new plan makes its own decision and does not inherit the old approval
- Authorization missing — managed care plans often require approval before delivery
Your move
What to do next.
- Read the letter closely. It states the exact reason and your appeal deadline. Deadlines are strict — do not let it sit.
- Fix the paperwork, if that is the issue. If documentation is the problem, the prescribing doctor’s office is usually where the fix happens.
- Appeal within the deadline if the denial looks wrong for your situation.
- Check the other door. A different benefit, a spouse’s plan, or Medicaid secondary coverage may apply.
- Keep the home set up meanwhile. A month-to-month rental bridges the gap — no prescription is needed for a self-pay rental; a prescription is required only when insurance is billed.
One call sorts out where you stand: (516) 623-9500. We verify benefits before delivery on every rental — see how coverage works on our insurance page, and if you are a clinician sending orders, our referrals page.
Questions, answered.
Plans differ, and we cannot speak for yours — but we can help you read the letter and understand the rule behind it. Call (516) 623-9500.
Why did Medicare stop paying for the hospital bed after 13 months?
Most equipment rentals are capped rentals: Medicare pays a monthly rental for 13 months, and then ownership of the equipment transfers to the patient. The payments stopping at month 13 is the rule working as designed — not a denial. After ownership, Medicare may help with maintenance and servicing.
Why did the oxygen payments stop after 36 months?
Oxygen follows a longer timeline: Medicare pays the rental for 36 months. After that, the supplier must keep providing the oxygen equipment for the rest of its 5-year reasonable useful lifetime, without monthly rental payments. When the 5 years are up, replacement equipment can start a new cycle.
My claim was denied. Can I appeal?
Yes. The denial letter states the reason and your appeal deadline — read both carefully, because deadlines are strict. Many denials come down to paperwork: a missing prescription detail or documentation that does not fully support medical necessity. Fixing the documentation with the prescribing doctor is often what decides an appeal. We can help you understand the stated reason.
I switched insurance plans and my rental stopped. Why?
A new plan does not automatically continue the old plan’s rental. The new plan makes its own coverage decision, and paperwork may need to be resubmitted. If you are switching plans, call your supplier before the switch so coverage is verified with the new plan in advance.
What if we still need the equipment?
Month-to-month rental is the straightforward bridge: no prescription is needed for a self-pay rental, so the home stays set up while an appeal or a new coverage decision plays out. A prescription is required only when insurance is being billed.