Changes in a patient’s health insurance can disrupt billing and care continuity. Unlike other areas of healthcare, durable medical equipment often involves long-term rentals, sometimes lasting a year or more. That means the insurance landscape you started a claim under may not be the one you’re billing months down the line. If you’re not ready for it, you can end up with languishing (or denied) claims.
Ahead, what you should know as we head into the new year.
Why Insurance Changes Are a Uniquely DME Challenge
Imagine this scenario: a patient rents a wheelchair in March under an insurance plan with coverage and expectations set for a long rental. In October, their job changes, and they become eligible for a different plan. Suddenly, the payer on that rental changes mid-agreement.
This isn’t uncommon. Studies show that 15% to 20% of publicly and privately insured patients experience coverage changes or disruptions every year. Employer changes, eligibility shifts in Medicaid or Medicare Advantage, and life events like moving or job loss can all lead to a change in plans (literally).
For DME providers, every insurance change introduces administrative complexity:
- Patients’ eligibility for continued coverage may differ (e.g., changes in benefit limits, prior authorization requirements).
- Claims billed to the wrong insurer are more likely to be rejected or denied.
- Payments may be delayed while coverage and responsibility are determined.
All of this can lead to cash flow interruption, increased AR days, and a heavier workload for your billing team.
Dealing with billing team turnover? How AI Can Support Lean DME Billing Teams
The Consequences of Reacting to Insurance Changes Instead of Planning for Them
If your business isn’t prepared for insurance changes, it can strain both your revenue cycle and your operations. Health insurance churn is not rare: Studies tracking coverage change rates suggest that about 5% to 10% of patients seen in a given period will have changed insurance, underscoring how often this issue occurs for billing teams.
When coverage changes aren’t caught early, claims are more likely to be submitted with outdated or incorrect payer information, which directly contributes to billing inefficiencies and financial setbacks. Across U.S. healthcare (not limited to DME), denial rates remain high. For example, marketplace plans on HealthCare.gov denied nearly one in five in-network claims in 2023, and many providers report that claims are denied 10% or more of the time.
These denials frequently stem from administrative or eligibility errors rather than clinical ones, meaning that updating patient coverage information early could prevent a significant share of them.
The financial consequences of these denials go beyond delayed payment: correcting and rebilling denied claims consumes staff time and operational resources, which can slow cash flow and inflate accounts receivable. Widely reported industry data shows that denial management challenges are rising, with nearly 75% of revenue cycle leaders saying denials have increased, and that errant data and payer policy changes are common drivers.
Finally, the downstream effects reach patients. Coverage mismatches can lead to unexpected out-of-pocket costs or gaps in equipment delivery or authorization, which undermine patient satisfaction and trust. By catching insurance changes early, you not only safeguard your revenue cycle—you also help patients avoid confusion and financial surprises at the point of care.
Your EOY Checklist
If you haven’t already started prepping for 2026, now is the time. Here’s a concrete process your team can implement immediately:
Run a Pre-Holiday Insurance Verification Sweep
Contact active patients with ongoing rentals before the end of December. Confirm:
- Current insurance carrier and policy number
- Effective date and coverage details
- Whether there’s been any recent job change, life event, or open enrollment action
Use automated eligibility checks where possible, but always follow up with a call for any high-risk cases. This should be part of a year-end eligibility verification drive that becomes standard practice.
Reach Out to Patients Proactively
Don’t wait for patients to inform you of a change. Many won’t realize it affects billing or won’t think to tell you.
In late November through early December, send personalized outreach:
- Emails or text reminders to validate insurance
- Calls to patients with long-term rentals
- Alerts around open enrollment windows (especially Medicare Advantage and ACA plans)
Getting ahead of this before January 1 dramatically reduces coverage surprises.
Related: Should You Be Auditing Your Own Patient Communication Records?
Build an Insurance Change Workflow
Create or refine your process so that every time a change is detected, your team can act in a predictable and efficient way:
- Document the new insurance in your system.
- Re-verify eligibility and benefits specific to the equipment being rented or supplied.
- Verify prior authorizations and renew if needed under the new plan.
- Update billing and submit claims under the correct payer.
Train staff on this workflow and assign clear roles (from schedulers to billers) to avoid confusion and delays.
Track and Trend Insurance Changes
Set up a monthly report that captures:
- How many patients changed coverage
- Which payers you interact with most frequently
- Denial patterns tied to coverage gaps
Use this to predict potential workflow bottlenecks and resource needs, especially early in the year when churn tends to spike.
Don’t Let Insurance Changes Catch You Off Guard
Insurance churn is a reality in U.S. healthcare. For DME providers, that churn represents a business challenge that impacts billing, cash flow, and patient experience.
With a proactive approach now, you can reduce denials, avoid revenue delays, and start 2026 with your processes in order.
If you want help refining your insurance change workflow or need support tackling denials tied to payer switches, reach out. We can help you build a process that keeps coverage changes from becoming costly surprises.