A) CLINIC REIMBURSEMENT "WITH / WITHOUT" DOCTORS PRESCRIPTION

• Doctor writes a prescription for FLEXTEND.
• Clinic bills patients Insurance Company along with a copy of: -Prescription for FLEXTEND Orthotic (If Available) -Medical Necessity Form -Patient Chart Notes -FLEXTEND "Product Description" -Billing Code -Product Invoice

B) PATIENT REIMBURSEMENT "WITH / WITHOUT" DOCTORS PRESCRIPTION

• Patient Purchases FLEXTEND.
• Patient bills their Insurance Company along with a copy of: -Prescription for FLEXTEND Orthotic (If Available) -Medical Necessity Form -Patient Chart Notes (Send copies if available) -FLEXTEND "Product Description" -Billing Code -Product Invoice

C) THIRD-PARTY BILLING

• Doctor writes a prescription for FLEXTEND and forwards to Insurance Representative.
• Insurance Representative faxes patient name, company name where patient is currently employed,and invoice/order to Balance Systems Inc.(BSI)

• BSI bills insurance company for FLEXTEND.
• BSI sends FLEXTEND directly to patient.
• Payment due by Insurance Company upon receipt of invoice.

MEDICAL BILLING CLASSIFICATION: CPT AND HCPCS CODES

1) E-1399

2) L-3912

3) L-3984

4) L-3999

INSURANCE COMPANIES COVERING FLEXTEND

• QualMed (HMO)
• Blue Cross / Blue Shield
• Johnson & Culbertson
• Washington Hospitals
• Tri-Care (Champus)
• Associated Administrators
• Labor & Industries
• O.D.S. Health Plan
• Aetna Life
• Adventist Risk
• PacifiCare
• Regence
• Safeco
• SAIF
• Humana
• First Option Health Insurance
• Federal Workers Comp.
• State Fund Workers Comp.
• Prescription Mngt. Services, Inc.
• Republic Indemnity Company of America
• Chubb Services Corporation
• Safeway Risk Management
• Kemper Insurance
• Genex Services
• Fremont Compensation
• Principal Life Insurance Company
• Medicare Part-B
• Arizona Foundation for Medical Care