Low Air Loss Mattress: When to Use It and How to Get It Covered
What is low air loss mattress?
A low air loss mattress is a pressure-relieving mattress used to prevent and treat bed sores (pressure ulcers). The mattress is designed with multiple air chambers that alternately fill with air and deflate so that pressure on the skin is constantly changing. This alternating action relieves pressure from bony prominences (hip joints, shoulders, elbows, heels) by changing the pressure of the surface below them.
By relieving the pressure from these areas and allowing air to circulate beneath and around them, bed sores are treated and prevented. While there are many different brands of low air loss mattresses the function of the mattress remains the same. When the need to heal or prevent pressure ulcers arises, this mattress is the one to choose.
What is a pressure ulcer?
A pressure ulcer is a sore on the skin caused by constant pressure. The pressure on the skin does not allow blood and oxygen to flow to that area. This can cause the area to breakdown or open. While pressure ulcers begin as reddened areas on the skin, severe pressure ulcers are open wounds and can extend through muscle and to the bone.
Who can benefit from a low air loss mattress?
Low air loss mattresses are typically used in caring for those who currently have pressure ulcers, have signs of pressure ulcers, or are immobile. Immobility leads to prolonged pressure on the shoulders, elbows, hips and heels. Those who are immobile and unable to turn and re-position in bed are have the highest risk of developing pressure ulcers. Some who can benefit from a low air loss mattress are:
- paraplegic or quadraplegic;
- hospitalized in intensive care;
- terminally ill;
- recovering from surgery.
When should a low air loss mattress be used?
A low air loss mattress should be considered for those who:
- are primarily bed confined;
- are not bed confined but have signs of developing pressure ulcers;
- already have an open (Stage II or higher) pressure ulcer.
Although these mattresses are used for the most part in caring for those with either developing or open pressure ulcers, it is also important to consider those who are bed confined for long periods of time. Further, the terminally ill and dying should not be excluded from consideration for the mattress as their skin is very fragile and prone to breakdown.
How to get a low air loss mattress covered
Medicare. The Medicare criteria for a low air loss mattress will vary slightly from one area of the U.S. to another. Beginning criteria for payment by Medicare are:
- multiple pressure ulcers on the body trunk and pelvis;
- use of a Group 1 pressure relieving device for 30 days;
- documentation of participation in a comprehensive ulcer treatment program;
- documentation that the wounds have either worsened or stayed the same over the past 30 days.
Medicaid. Coverage criteria by Medicaid will mirror that of Medicare in the state in question.
Third-Party Health Insurance. Third-party health insurance guidelines for coverage will vary from one insurer to another. To determine benefits, contact the benefits department of the insurance for a summary of benefits for Durable Medical Equipment (DME). Then, determine if there is a deductible to be met and/or a co-pay to be paid.
Hospice. Under the Medicare Hospice Benefit any and all medical equipment that is necessary to the comfort of the patient is covered. For those who are terminally ill and suffering from pressure ulcers, a low air loss mattress may be provided by hospice at no charge to the patient or family.
Hospice benefits of third party insurance companies will vary from one company to another. To determine benefits, contact the benefits department of the insurance for a summary of benefits for Hospice. Ask if the hospice benefit includes Durable Medical Equipment (DME). Then, determine if there is a deductible to be met and/or a co-pay to be paid.
Private Purchase. In the event the mattress is not covered by insurance, the mattress may also be purchased privately at your own expense from a medical equipment company or online. Expect to pay between $500 and $800 for a good quality low air loss mattress.
To get a low air loss mattress paid for by Medicare, I need
How do I get a low air loss mattress?
A physician's prescription and a Certificate of Medical Necessity will be required by Medicare, Medicaid and third-party insurance companies. A Certificate of Medical Necessity is a form completed by the physician that indicates why the low air loss mattress is needed and what type of treatment has taken place so far. Hospices are required to provide this type of equipment when medically necessary and will only require a physician's order. If you purchase the mattress at your own expense, no documentation from the physician is required.