AVOGEL INSURANCE ORDER CONTACTS AND FORMS

Prescriptions for Avogel® Hydrogel Sheeting is covered by most insurance companies, including Medicaid and Medicare. Your physician or physical therapist must complete the attached prescription form below. The form must be sent to a special type of pharmacy that handles dressings and medical equipment called a Durable Medical Equipment ("DME") pharmacy. The DME pharmacy will process the prescription through your medical insurer. If your insurance companies indicates that Avogel is not on their automatically covered list, your physician or therapist will need to explain the need for Avogel. Please contact us directly if we can advise you get started with the insurance reimbursement process. Our toll free number is 1 (866) 352-7227.


Avogel ®

For the handling of insurance billing, the following DME pharmacies are able to process Avogel ® and Avosil ®.
BVM

BVM Medical Supply

Phone: (847) 885-8800 | Fax:(847) 885-8910

Mark Drugs

Mark Drugs Medical Supply

Phone:(847) 537-8500 | Fax: (847) 537-9430

ScriptSave

ScriptSave® WellRx

Phone: 1-800-407-8156



General Insurance Forms



Avogel®Burn Insurance form


Avogel®Occupational Therapy Insurance form

Copyrights ©2016 Avocet Polymer Technologies, Inc. All Rights Reserved