Insurance Reimbursement And Medical Classification:

1. Reimbursement:
   
   
   1. Consumer Reimbursement
      
      Consumer purchases FLEXTEND®.
      Consumer bills patients insurance along with a copy of:
      
      • FLEXTEND® Product Description.
      • Billing code.
      • Product invoice (If needed).
      • Medical Necessity or Physicians Prescription
        
        
   2. Hospital and Clinic Reimbursement With Doctors Prescription.
      
      • Doctor writes a prescription for FLEXTEND®.
      • Clinic bills patients insurance along with a copy of:
        
        • Patient chart notes.
        • FLEXTEND® Product Description.
        • Billing code (See Section 'C' Below).
          
          
   3. Hospital and Clinic Reimbursement Without Doctors Prescription.
      
      • Clinics purchase FLEXTEND®.
      • Clinic bills patients insurance along with a copy of:
        
        • Patient chart notes.
        • FLEXTEND® Product Description.
        • Billing code.
        • Product invoice (If needed).
        • Medical Necessity
          
          
   4. Third-Party Billing:
      
      • Doctor writes prescription for FLEXTEND®.
      • Third party representative faxes company name, employee name, and invoice/order to Balance Systems Inc. (BSI).
      • BSI bills third party agency for FLEXTEND®.
      • BSI sends glove directly to patient.
      • Payment due by third party agency upon receipt of invoice.
        
        
2. FLEXTEND® / RESTORE™ Is Billed Using The Following HCPCS Codes:
   
   L-3912 : WHFO flexion glove w/ elastic finger control
   L-3999 : Unlisted procedure for upper arm / limb orthosis.
   L-3984 : Upper extremity fracture orthosis, wrist.
   E-1399 : Swanson finger crush.
   
   
3. Print Product Description and send to insurance company along with invoice, Medical Necessity and/or Physician's Prescription.
   
   
4. Print the Medical Necessity form and have a healthcare professional fill it out (if you do not have a Physician's Prescription) and send to insurance company along with Product Invoice and Product Description.
   
   
5. Food and Drug Administration (FDA):
   
   1. FLEXTEND® has been registered with the FDA.
   2. FDA Device Listing Number: 21-CFR 890.5350
   
   
6. FLEXTEND® / RESTORE™ Insurance Companies that have Paid
   
   1. QualMed (HMO)
   2. Blue Cross / Blue Shield
   3. Johnson & Culbertson (Workers Comp.)
   4. Washington Hospitals (Workers Comp.)
   5. Tri-Care (Champus)
   6. Associated Administrators (Regence / Private)
   7. Labor & Industries
   8. O.D.S. Health Plan
   9. Aetna Life (Assoc. w/ Medicare)
   10. Adventist Risk (HMO / Private)
   11. PacifiCare (HMO)
   12. Regence (HMO)
   13. Safeco (Workers Comp.)
   14. SAIF (Workers Comp.)
   15. Humana
   16. First Option Health Insurance
   17. Federal Workers Comp.
   18. State Fund Workers Comp.
   19. Prescription Management Services, Inc.
   20. Republic Indemnity Company of America
   21. Chubb Services Corporation
   22. Safeway Risk Management
   23. Kemper Insurance
   24. Genex Services
   25. Fremont Compensation
   26. Principal Life Insurance Company
   27. Medicare Part-B
   28. Arizona Foundation for Medical Care
   • This is only a partial list of Insurance Companies that provide reimbursement.