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
MEDICAL INSURANCE CLAIMS CAN TAKE UP TO 10 MONTHS BEFORE YOU RECEIVE YOUR CHAIR
FILL OUT THE MEDICAL INSURANCE FORM ONLY AFTER YOU COMPLETE STEPS 1 & 2
FILL OUT THE MEDICAL INSURANCE FORM BELOW
Please complete the form below to assist us in submitting a claim to 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.
We DO NOT use Local Dealers or Third Parties to Handle Medical Insurance Claims - We Bill Direct!