| We
offer extensive insurance billing and assistance that includes:
checking initially on coverage and letting the patient know
up front what the out-of-pocket cost will be; obtaining letter
of necessity and prescription from physician and obtaining pre-authorization;
submitting claims for the patient; appealing denied claims;
submitting claims to secondary insurance companies; and weekly
checking on submitted claims and updating patient on status
of claims.
PLEASE
FILL OUT THE FORM BELOW AND PRESS SUBMIT.
(By pressing submit after reading this
authorization, you agree to the terms described). I AUTHORIZE
PAYMENT OF MEDICAL BENEFITS TO DIABETES EQUIPMENT & REFERRAL
SERVICE FOR THE SERVICE DESCRIBED IN THE ATTACHED INSURANCE
CLAIM FORM. I UNDERSTAND THAT INSURANCE BILLING IS A SERVICE
PROVIDED AS A COURTESY AND THAT I AM AT ALL TIMES RESPONSIBLE
FOR ANY FEE NOT PAID BY MY INSURANCE CARRIER WITHIN 60 DAYS
OF THE DATE OF SERVICE OR IMMEDIATELY UPON NOTIFICATION OF
A CLAIM DENIAL.
|
