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Avogel

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.





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Burn Insurance Form (pdf)

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Occupational Therapy Insurance Form (pdf)

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