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Insurance Forms
No Up-front Costs For Some Items!

For some items, such as diabetic supplies, mastectomy forms and bras, some incontinence supplies, even wheelchairs and much more, there may be no up-front costs. This means we will bill Medicare or your insurance carrier, then only bill you for the amounts not covered, (such as deductibles and co-pays). Our insurance specialists are always happy to review your particular supply needs and discuss this wonderful benefit.

Complimentary Medicare and Insurance Billing!

We will gladly bill Medicare or your insurance company on your behalf for any qualified purchases made on our site. You can call us at (800) 755-7880 for details. If you would like to provide us with your insurance details online, please feel free to fill out our Secure Medicare Insurance Form. We will input your information into our system and send a bill either electronically to Medicare or by mail to your insurance company so reimbursement will be sent directly to you. Be sure to log in as a customer so we have your correct address to have your payments sent to as well as your correct phone number in case we need to contact you with insurance questions.

Sorry, No HMOs

Unfortunately, many HMOs will not pay out of plan. Therefore we cannot bill them direct, but we can send you a claim form. Contact your HMO representative and ask them about their polices on Internet purchases. Perhaps they will reimburse you directly for purchases made for which you have a prescription from your doctor. We will provide you with a standard 1500 insurance claim form at your request, or if you fill out the above information.

 

 

 

Secure Insurance Form
Secure Medicare
Insurance Form
(online)

Secure Insurance Form
Assignment of
Benefits (AOB) Form
(pdf)


About the AOB Form
Only by completing, signing, and sending or faxing the Assignment of Benefits (AOB) form can we do all your paperwork for you and bill Medicare or your insurance company for all your medical supplies.

 


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Blood Pressure Equipment | Blood Pressure Monitors | Diabetic Test Strips | Diabetic Testing Supplies
Mastectomy Swimwear | Mastectomy Products | Urinary Catheters | Intermittent Catheters


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