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Insurance Billing Information

Insurance Reimbursement And Medical Classification:

  1. Reimbursement:

    1. Consumer Reimbursement With or Without Physicians Prescription
      • Consumer purchases FLEXTEND®.
        Consumer obtains billing forms from their insurance carrier and bills insurance company 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:
    3. Hospital and Clinic Reimbursement Without Doctors Prescription.
      • Clinics purchase FLEXTEND®.
      • Clinic bills patients insurance along with a copy of:
    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
    : Unlisted procedure for upper arm / limb orthosis.
    : 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
    • NOTE This is only a partial list of Insurance Companies that provide reimbursement.
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