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Referral Information
Physicians / Physical Therapists
- We only work with Group, PPO’s and fee for service plans, worker’s compensation and first-party auto claims.
- Once you find a patient who will benefit by Electro medicine, download and print the Letter of Medical Necessity and the Patient Information Form. (You need Adobe Acrobat Reader to view and print this form. See the button below to download the reader if you do not have it.)
- Fill out both forms with doctor’s and patient’s signature and fax it to use toll-free at (800) 588-9282.
- We will authorize the patient and call you with an approval as soon as we get one. (usually within 4 hours).
Case Mangers, Medical Managers and Insurance Agents
- If you have a referral for us to handle, just download and
print the insurance form.(You need Adobe Acrobat Reader to
view and print this form. See the button below to download the reader if you do not
have it.)
- Fill it out completely and sign it
- Fax it to us toll-free at (800) 588-9282 (attention cost
containment department)
- We will follow up with your patient within the first 30 days for compliance, to reconfirm our policies and to make sure they have atleast four ways to contact us.
- If we find out that the patient is not using the modality, we will
cancel supplies and stop billing for any of our services.
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