We are “In-Network” for over 450+ Health Insurance Providers!

From the National Providers to the Smaller Regional Providers Too!

FILL OUT THE MEDICAL REIMBURSEMENT FORM BELOW

Medical Reimbursement

Please complete the form below to assist us in creating your Medical Reimbursement for your insurance provider. It is our passion to do whatever we can to help our customers break free from their physical prisons, and find freedom, independence, and mobility. In our pursuit of this passion, we have done all the legwork so we can be "In-Network" so you can get reimbursed for your FOLD & GO WHEELCHAIR.
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  • Many insurance providers require prior authorization for a portable electric wheelchair. Call your provider to see if your policy requires prior authorization.

  • Please upload an image of the FRONT of your medical insurance card.
    Drop files here or
    Accepted file types: jpg, gif, png, pdf, bmp, tiff, doc, docx.
  • Please upload an image of the BACK of your medical insurance card.
    Drop files here or
    Accepted file types: jpg, gif, png, pdf, bmp, tiff, doc, docx.
  • If you have any unique instructions for us, please let us know.
  • FOLD & GO WHEELCHAIRS® creates a Medical Reimbursement Invoice for our folding electric wheelchairs (K0012) as per the advertised purchase price listed on our website. We do not inflate the purchase price of our wheelchairs when we create your invoice, and we don’t have contracted discounted pricing with ANY insurance provider. Whether our customers pay by cash, credit card or their DME insurance provider, the purchase price is the same for everyone!