Three Reasons To Buy An Over-the-Counter TENS Device Rather Than Use Health Insurance
Congratulations for deciding, in consultation with your physician, to evaluate transcutaneous electrical nerve stimulation (TENS) for your chronic pain. You have taken the first step to reclaiming your life from chronic pain and decreasing your reliance on pain medications. What happens next? Should your physician write a prescription that is submitted to a Durable Medical Equipment (DME) supplier that is contracted with your health insurer or should you purchase an over-the-counter (OTC) TENS device on-line or at your local pharmacy?
DME suppliers are accredited companies that serve as an intermediary between patients and health insurance companies. DME suppliers provide patients with home use medical equipment such as TENS, crutches, wheelchairs and blood glucose monitors and then bill insurance companies for contracted amounts and collect co-pays from patients.
Now, getting back to the questions above. If you do not have health insurance, then the answer is nearly always that you should purchase an OTC TENS of your choice. It will be less expensive than the cash price offered by most DME suppliers.
What if you have health insurance? You might initially assume that the cost of the TENS unit and supplies, such as electrodes and batteries, will be covered, and you won’t have to pay anything. Well, probably not. Insurance coverage for TENS is complex. There are many medical and documentation requirements that must be met, with the details changing frequently. There are also limitations on what pain conditions are covered. For example, Medicare does not reimburse TENS for low back pain. The end result is that you may end up paying more, potentially a lot more, if you go through insurance rather than buying an OTC TENS device. Moreover, if you go through insurance you will have no choice in what TENS unit you receive and may be given outdated technology.
In this blog post we cover three reasons that you should consider buying your own TENS device rather than going through insurance.
If you obtain a TENS device though your health insurance, then you will have little or no choice. Most DME suppliers carry just one TENS unit that they have chosen for various reasons. They may feel that the device provides the capabilities typically requested by health care professionals they work with. Another reason may be that the TENS unit has a low cost. DME suppliers usually receive a fixed amount from the insurer regardless of the actual cost of the device. If they pay more, their profits are reduced.
So, if having a choice is important to you, then your best option is to purchase an OTC TENS device. There are over a hundred such devices with different features and prices. For example, if you have knee or leg pain and are looking for a 24-hour pain relief, then Quell® may be your best choice. If you only need 30-60 minutes of pain relief every few days, then there are many effective, low-cost OTC TENS devices. There are also devices that are designed for particular parts of the body such as the low back. The key is that you can choose an OTC TENS unit that addresses your particular pain relief needs and fits into your lifestyle. You have numerous choices in every aspect of our life, pain relief should be no different.
Although it may seem counterintuitive, the most innovative TENS devices are those available OTC rather than the older prescription units offered by DME suppliers. Originally, prescription TENS devices were the most technologically advanced. However, over the past 10 years nearly all new innovations have been introduced in OTC devices. For example, only OTC TENS units offer a mobile app for your smartphone. The Quell wearable pain relief device even communicates with your Apple Watch®.
For the most part, prescription TENS devices have not changed in the past decade. DME insurance billing creates disincentives to innovation. DME suppliers cannot charge more for technologically advanced TENS devices because of fixed insurance payment amounts. As another example, DME suppliers are reimbursed for providing you with regular batteries, which discourages them from offering devices with more convenient and efficient rechargeable battery technology.
Despite what a DME supplier may initially promise, you could end-up paying hundreds of dollars for outdated TENS technology if you go through health insurance. TENS is often only partially covered or may be entirely non-covered under your health insurance plan, so you can be left with a large bill if your insurer rejects some or all of the claim. Unlike OTC devices that are competitively priced, DME suppliers charge high prices for TENS to cover their administrative costs of insurance billing and to generate profits. Another important point to consider is that TENS is usually subject to copays and deductibles. DME suppliers are legally required to collect copays, which can run 20% or more of the billed amount. If your deductible has not been met, then you will essentially pay outright for the TENS unit provided by the DME supplier. This is often the case early in year and for those on high deductible health insurance plans.
TENS is not effective for everyone. The only way to know if you will experience pain relief is to trial a device. Most OTC TENS units come with a money back guarantee. For example, Quell offers a no-risk 60-day trial which provides plenty of time to determine if it is helpful in managing your chronic pain. By contrast, TENS units obtained from a DME supplier are billed immediately, usually as a rental. You may therefore incur expenses before knowing whether TENS is effective for your particular pain.
As a final and particularly important point on costs, you can purchase an OTC TENS unit using your FSA or HSA funds.
This post provided three reasons why you should consider buying an OTC TENS device rather than trying to use your health insurance benefits: choice, innovation and cost. Because every patient and situation are unique, you should discuss your options with your physician and insurance representative.
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