Order by Prepayment
We use California MediCare pricing for all of our custom orthotics.
Every order will be assessed a delivery/handling charge. Our invoices will have
a procedural breakdown for each orthosis for insurance reimbursement
purposes. When seeking reimbursement, the patient can submit our invoice
marked "paid" coupled with the prescription for the orthosis to their insurance
company. The patient's diagnosis needs to be on the doctor's
prescription. In some instances, insurance companies may request that a Letter
of Medical Necessity be provided, and this should be provided by a Physician. We cannot guarantee insurance reimbursement on
any items due to the differences in individual policies and circumstances. You
may wish to consult with your insurance provider prior to ordering.
There are also a few optional items that may not be reimbursed through
insurance. For this reason, we have kept these items at a minimal cost.
In addition, insurance companies generally do not reimburse for casting,
fitting, delivery, or shipping costs.
To view a sample prescription form
click
here
To view a sample
prescription form for the PRO
click here
FOR UPPER EXTREMITY ORTHOTICS
- Once we receive the completed
Upper Extremity Measurement Form,
the completed
Patient Information Sheet,
and a copy of the prescription with the diagnosis on it, a price can be determined for an order. We will notify the billing
party (patient/therapist/facility) of the total price, including delivery and
handling charges, within two business days.
- Once we receive payment the brace will then be shipped
to the therapist within
10 business days.
- Upon delivery, the therapist must do the
fitting.
FOR THE Perfect Response Orthotic®
- We must receive the completed
Patient Information Sheet,
video, and a copy of the prescription with the diagnosis on it, before we can process an order. Once all
items have been received via email, fax or mail, a price can be determined
for an order. We will notify the billing
party (patient/therapist/facility) of the total price, including delivery and
handling charges, within two business days.
- A cast will then need to be taken of the patient and sent to us
via mail along with the payment in the form of a check or credit card payment.
- The brace will then be shipped to the
therapist within 10 business days.
- Upon delivery, the therapist must do the fitting.
FOR THE
PRO
Insole™
- We must receive the completed
Patient Information Sheet,
and a copy of the prescription with the diagnosis on it, before we can process an order. Once all
items have been received via email, fax or mail, a price can be determined
for an order. We will notify the billing
party (patient/therapist/facility) of the total price, including delivery and
handling charges, within two business days.
- If ordering the
PRO
Insole™ at the same time your are ordering the Perfect Response
Orthotic® or within 6 months of ordering the
Perfect Response Orthotic® a cast does not
need to be taken. If ordering the PRO
Insole™ after 6 months of ordering the Perfect Response Orthotic® or
if the patient never ordered the Perfect Response Orthotic® then
a cast will then need to be taken of the patient and sent to us
via mail along with the payment in the form of a check or credit card payment.
- The brace will then be shipped to the
therapist within 10 business days.
- Upon delivery, the therapist must do the fitting.
FOR "OTHER" ORTHOSIS
- Once we receive the completed
Patient Information Sheet, and a copy of the prescription with the diagnosis on it, a price can be determined for an order. We will notify the billing
party (patient/therapist/facility) of the total price, including delivery and
handling charges, within two business days.
- Once we receive payment the brace will then be shipped
to the therapist within
10 business days.
- Upon delivery, the therapist must do the
fitting.
We will not begin fabrication until
we receive payment in full or a P.O. number. A personal check, cashier's check or money
order made payable to KineMedic Concepts, Inc. is acceptable. You can also
pay by credit card. Purchase Orders can be arranged through a
hospital/facility. The hospital/facility can contact our office for
information.
IF PAYING BY CHECK, PLEASE MAIL CHECK TO:
KINEMEDIC CONCEPTS,
INC., P.O. BOX 3220, BLUE JAY, CA 92317
IF PAYING BY CREDIT CARD PLEASE COMPLETE CREDIT
CARD ORDER FORM BELOW AND FAX, EMAIL, OR MAIL IT TO US.
Credit
Card Order Form
Note: Any mail sent to us using the U.S. Postal
Service can be mailed to KINEMEDIC CONCEPTS, INC., P.O. BOX 3220, BLUE
JAY, CA 92317
If using ANY other mailing service
(such as UPS or any other ground carrier) please call us for our physical
address.