Full Electric Bariatric (Heavy Duty) HomeCare Bed Eligibility

Full Electric Bariatric (Heavy
Duty) HomeCare Bed
Eligibility Requirements for a
Semi-Electric HomeCare Bed
Medicare:
A Heavy Duty, Extra Wide hospital bed (E0301, E0303) is
covered if patient meets one of the below criteria and the patient’s
weight is greater than 350 lbs but does not exceed 600 lbs.
1) The patient has a medical condition, which requires positioning
of the body not feasible with an ordinary bed (i.e., raising of feet/
legs and/or head greater than 30 degrees).
2) The patient has a medical condition, which requires body
positioning not feasible with an ordinary bed to alleviate pain.
3) The patient needs the head of the bed elevated more than 30
degrees most of the time due to CHF, CORD, or aspiration.
Pillows and wedges must have been considered and ruled out.
4) The patient requires traction equipment, which can only be
attached to a hospital bed.
Medi-Cal:
Rails and Heavy Duty Foam Mattress Included. Physician’s prescription and TAR required
Other options may be availalbe upon request. Health Plan of San Joaquin:
• Quiet, smooth operation.
• Heavy duty frame ensures strength and patient safety.
• All steel construction.
• Larger sleep surface than conventional bed.
• Quiet, smooth operation.
• Split pan design with removable bed ends is easy to set-up.
• No tools necessary for set-up.
• Hand control (included) provides for multiple bed positioning
for patients.
• Low air loss/alternating pressure mattress available.
• Emergency manual crank included.
• Warranty: (Original purchaser) Lifetime on welds, 5 years on
frame, 1 year on all other parts and components.
• Weight Capacity: 600 lbs.
Specifications
Bed Height Min:
Bed Height Max:
Overall Length:
Mattress Length:
Overall Width:
Mattress Width:
Overall Weight:
Weight Capacity:
Warranty:
18.25”
26.25“
88”
80”
42“
42”
276 lbs.
600 lbs.
5 Year Limited Warranty
Physician’s Prescription required; Pre Authorization required;
Active Life Medical is here to help make the outpatient process as easy
as possible for you and your patient. We are dedicated to bringing the
highest quality products and customer service to you and your patients.
We are excited for the opportunity to become your partner in outpatient
care.
HomeCare Beds Covered by Medi-Cal,
Medicare, Health Plan of San Joaquin,
and other Insurances.
Why send your referrals to Active Life?
• We will assist in communicating with the doctor to obtain prescriptions
• We will handle meeting with the patient, the patient’s family, and
caregivers to review available products and services
• We will check all of the patient’s qualification requirements for billing
purposes
• We have a team of friendly staff that understands your patient's needs
and will help make their transition as hassle free as possible
• We keep a wide variety of products in stock locally and offer a
dependable delivery service that your patients can count on
• We specialize in providing top quality disposable and durable medical
equipment
• We will provide Medi-Cal, Medicare, and insurance billing services on
the patient's behalf
How does it work?
• Simply fill out one of our Patient Referral Fax Forms
1. Get the form from activelifemed.com/PRFF
2. Call 800-511-9744 to request the form
3. Fax us your request for the form 866-411-7344
4. Email us to request the form [email protected]
• Be as complete as possible when filling out the form, missing
information can delay shipment
• Send the form back to us (where to send it below)
1. Fax the form to 866-411-7344
2. Email the form to [email protected]
We look forward to working with you.
Active Life Medical
Favor de llamar para ayuda en español
Telephone: (800) 511-9744
Board Of
Monday - Friday
Certification/Accreditation,
8:00 am - 5:00 pm
International
email: [email protected]
THE ADVANTAGE IS EXPERIENCE™
www.activelifemed.com
Active Life Medical - 4217 Coronado Ave Unit D - Stockton, CA 95204
Delta Ultra Light 1000, SemiElectric HomeCare Bed
Eligibility Requirements for a
Semi-Electric HomeCare Bed
Reduce Risk of Pressure Ulcers
with a Gel/Foam Overlay
Medicare:
A Semi-electric hospital bed (E0260, E0261, E0294, E0295) is
covered if patient meets one of the below criteria and requires
either frequent or immediate need for changes in body position.
1) The patient has a medical condition, which requires positioning
of the body not feasible with an ordinary bed (i.e., raising of feet/
legs and/or head greater than 30 degrees).
2) The patient has a medical condition, which requires body
positioning not feasible with an ordinary bed to alleviate pain.
3) The patient needs the head of the bed elevated more than 30
degrees most of the time due to CHF, CORD, or aspiration.
Pillows and wedges must have been considered and ruled out.
4) The patient requires traction equipment, which can only be
attached to a hospital bed.
Medi-Cal:
Rails and 80” Inner Spring Mattress Included. Physician’s prescription and TAR required
Other options may be available upon request. Health Plan of San Joaquin:
• Truly universal because the headboards and footboards are
completely interchangeable with most manufacturers bed
ends, old and new.
• Headboard is taller than footboard to better fit home decor.
• The wood grain panels are break and scratch resistant.
• Foot section weighs 50% less than conventional foot
sections to make deliveries safe and easy.
• Unique motor is completely self-contained to reduce weight
and noise.
• The motor assembly can be installed and removed with
patient in bed.
• In the event of a power failure, a 9 volt battery, located in
the motor, can lower the head and foot sections nine times.
• New and improved hand pendant has large, easy to use
controls.
• Channel frame construction provides superior strength and
reduced weight.
• Extension kit available model # (15030EXTKIT) extends
length from 80" to 84".
Specifications
Bed Height Min:
Bed Height Max:
Overall Length:
Mattress Length:
Overall Width:
Mattress Width:
Overall Weight:
Weight Capacity:
Warranty:
12.75” with wheels off
24”
88”
80”
36”
36”
155 lbs.
450 lbs.
5 Year Limited Warranty
Physician’s Prescription required; Pre Authorization required;
Active Life Medical is here to help make the outpatient process as easy
as possible for you and your patient. We are dedicated to bringing the
highest quality products and customer service to you and your patients.
We are excited for the opportunity to become your partner in outpatient
care.
Why send your referrals to Active Life?
• We will assist in communicating with the doctor to obtain prescriptions
• We will handle meeting with the patient, the patient’s family, and
caregivers to review available products and services
• We will check all of the patient’s qualification requirements for billing
purposes
• We have a team of friendly staff that understands your patient's needs
and will help make their transition as hassle free as possible
• We keep a wide variety of products in stock locally and offer a
dependable delivery service that your patients can count on
• We specialize in providing top quality disposable and durable medical
equipment
• We will provide Medi-Cal, Medicare, and insurance billing services on
the patient's behalf
How does it work?
• Simply fill out one of our Patient Referral Fax Forms
1. Get the form from activelifemed.com/PRFF
2. Call 800-511-9744 to request the form
3. Fax us your request for the form 866-411-7344
4. Email us to request the form [email protected]
• Be as complete as possible when filling out the form, missing
information can delay shipment
• Send the form back to us (where to send it below)
1. Fax the form to 866-411-7344
2. Email the form to [email protected]
We look forward to working with you.
Active Life Medical
The Gel Overlay is available for both the SemiElectric and the Bariatric HomeCare Bed
• Ideal combination of gel bladders, high density foam shell
and support base.
• Optimal prevention, treatment and management of pressure
ulcers.
• One piece construction requires no assembly.
• 4 Elastic corner straps secures overlay to mattress.
• Urethane coated nylon cover is, water resistant and vapor
permeable.
• Vinyl base is stain resistant and waterproof.
• Designated head and foot sections.
Address Pressure Prevention early to help
avoid discomfort and permanent skin Damage
• Pressure Sores can develop quickly on individuals who are
unable to change positions regularly.
• Elderly people are at a higher risk to develop pressure sores
quickly due to softer skin.
• Chronic Conditions such as diabetes or artery disease that
prevent areas of the body from receiving proper blood flow
and nutrition.
• Incontinence can contribute to skin ulcers because moisture
may be in contact with the skin or a long period of time.
Recognize the stages of Skin Ulcers and
report changes to the physician immediately
Make sure to check the entire body, especially areas that are
high risk such as shoulders, heels, elbows, and sacral region
(lower back and buttocks) regularly.
If you notice reddened or darkened skin that will not turn white
when firmly pressed that may be a stage 1 skin ulcer.
Stage 1
Stage 2
Stage 3
Stage 4