I would like coverage for:
TENS Unit  Muscle Stim Unit  Infrex Plus  Microcurrent 
Would you like monthly supplies?  Yes   No   
Will you be using unit for pain?  Yes   No
 

PATIENT NAME:

HOME PHONE:  -   (Area Code plus the Phone Number)

EMAIL:

EMPLOYER:

Is your insurance through your employer?  Yes   No   
WORK PHONE:    Extension: 
(Area Code plus the Phone Number)
DATE OF BIRTH: 
ADDRESS: 
CITY: 
STATE:  ZIP CODE: 
 

PHYSICIAN NAME:

PHONE:  -
ADDRESS: 
CITY: 
STATE:  ZIP CODE: 
Do you have a prescription:  Yes   No   

(If NO, one needs to be obtained) can you obtain one:
Yes   No   
 

What kind of coverage plan do you have?

We do accept Medicare and in some states Medicaid.

Worker Compensation :  Yes   No   
PRIMARY INSURANCE CO. OR MCO NAME: 
PHONE:  -   (Area Code plus the Phone Number)
POLICY/GROUP OR CLAIM #: 

SOC.SEC#: OF INSURED: 

PATIENT:  
NAME OF INSURED:
D.O.B. OF INSURED:  
EMPLOYER OF INSURED:  
RELATIONSHIP TO PATIENT: 

Assignment of Insurance Benefits

I hereby Authorize payment of medical benefits to Medfaxx for services furnished. I further authorize the release of any medical information required to process an insurance claim on my behalf. I permit a copy of this authorization to be as valid as the original.

 

Avoiding Out Of Pocket Health Care Costs For Chronic Pain Diagnosis


  Often a patient does not know, or the company providing the products fail to inform, but most tens and Infrex accessories will be paid for by the health insurance companies, including Medicare.

    Unfortunately many chronic pain patients are not aware that the tens supplies and other topical pain treatments are covered by most insurance companies. The cost for an interferential/tens combination unit, or stand alone tens units are only the tip of the iceberg. It's the continuing cost of reusable electrodes, rechargeable batteries, pain patches, sleep aids, and skin care products that are the cost the patient often bears unnecessarily.

    The key to avoiding extra out of pocket costs is to have the purchase of the tens or Infrex unit in the record of the chronic pain patient such as the below diagnosis of:

  • Radiating Sciatica
  • RSD
  • Osteoarthritis
  • Shingles
  • Chronic Low Back Pain
  • Back Pain
  • Shoulder Pain
  • Joint Pain
  • TMJ
  • Lumbar Stenosis
  • Hip Pain
  • Neuralgia
  • Diabetic Neuropathy
  • and other diagnosis indicative of chronicity.

   Once the insurance company has a record of the purchase then in almost all cases the supplies will be covered each month, for as long as the patient has the unit and suffers from a form of chronic pain. The insurance companies are well aware of the reduced costs to them by using non drug treatment methods, plus drugs are a continuing cost often escalating and requiring additional drugs to offset the effects of the prescribed drugs already being used.

    In the case of Medicare patients the record of a tens unit purchase usually means between $32 - $64.00 per month of the necessary items are paid for by Medicare. In most situations this is enough for the patient to be able to successfully treat with their unit. Over the course of one year the savings to the patient will be between $384 - $768, and that's only the first years savings for the patient who is using a tens or Infrex unit!!

   
    

              One of the major issues in using any form of electrotherapy, exception being Infrex Plus due to short duration of treatment, is protecting ones skin when a self adhering electrode is covering the skin for hours at a time is skin protection.  This is especially true with a tens unit

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