In order for us to submit any billable medical equipment, whether rented or purchased, to your insurance carrier, we need to receive the following forms completed by you or your physician:
- Demographic Sheet
- Letter of Medical Necessity
- Completed Rental Agreement Form
Below, you will find Western Medical Equipment's Rental Agreement Forms, Demographics Sheet, and Sales Agreement. Please fill out the appropriate forms. Please note that in addition to the completed forms we will need a copy of the front and back of your insurance card in order to submit to insurance.
You can fax these to 877.468.1214 or send by email to firstname.lastname@example.org
**Please note that our insurance contracts are subject to change at any time without notice. This list does not guarantee insurance payment. It is ultimately the responsibility of the patient to verify network participation and individual plan coverage** .