High Tech Rehab Solutions
Our Products
 

Funding - Insurance Information

Insurance Cases

Download and complete the following forms and send the necessary information indicated below to:

Hightech Rehab Solutions
6335 Camp Bullis Rd. Suite 7
San Antonio, TX 78257

  1. Completed Patient Information Form


  2. Front and back copy of all insurance cards


  3. Speech Report following Medicare guidelines and any special Medicaid requirements


  4. Physician's Prescription - (Original; copy or fax is unacceptable)
    Speech Generating Device DME Prescription


  5. Assignment of Benefits Form with Provider Notice of Privacy Practices. This is to be signed by recipient
    Assignment of Benefits Form with Provider Notice of Privacy Practices


  6. Co-pay and deductible if there are plan limitations or no secondary insurance for Medicare beneficiaries

If you initially fax us this information, we will need you to follow up by sending us the original physician's prescription with original signature.

Please keep a copy of everything you send us for your records.

 

 

- Back to top -