Patients ONLY Must Fill Out Their Own Insurance Information - Individuals Consent is Required
CALL your Insurance Provider and Ask the Following Questions!
- Ask if your policy coverage needs a “Prior Authorization” BEFORE a claim is submitted.
- The Medical Billing Code (CPT/HCPCS) for our wheelchair is K0012.
- Ask what their coverage amount will be according to your policy. Then you will know exactly how much you will need to pay out-of-pocket.
1. GET A SCRIPT from your Medical Doctor. This script should have the following information:
- The Script should be written to cover a “Portable Electric Wheelchair“.
- Include all your Medical Diagnosis Codes (alphanumeric codes only).
- Include your Doctor’s Contact Information.
2. GET A LETTER OF MEDICAL NECESSITY from your Medical Doctor.
FILL OUT the Insurance Claim Form below AFTER you have completed Steps 1 & 2!
- We DO NOT hold partial claim information.
- We DO NOT accept fax copies with your medical information.
- Insurance companies process all claims electronically.
- Your claim will NOT be submitted with partial information