INSURANCE FORMS

Insurance Reimbursement Information

The Roll-A-Bout Knee Walker is the #1 doctor requested knee walker brand and due to its trust within the medical supply industry, insurance companies may reimburse your Roll-A-Bout cost via an Out of Network Gap Exception Coverage. To do this, you may request an “Out of Network Gap Exception Coverage” or “Gap Exception Coverage” from your insurance company.

For your convenience we provide reimbursement documentation for you to submit to your insurance company. The documentation you need is below:

  1. A Letter of Medical Necessity for your doctor to complete
  2. Your final itemized receipt

Both documents will have the device insurance billing code your insurance company needs for processing your reimbursement

The Letter of Medical Necessity (LMN) below is provided by our company at the time your order is placed and may be required by insurance to authorize payment for Durable Medical Equipment or other medical services. This form allows your doctor to provide everything your insurance company requires and includes our device’s billing code.

You must submit the LMN, completed and signed by your doctor, along with your rental or purchase receipt to your insurance company.

Letter-of-Medical-Necessity for Roll-a-bout (PDF DOWNLOAD)

Letter-of-Medical-Necessity for Cold/Compresssion Therapy (PDF DOWNLOAD)

Setup was a snap!

“The process went so smoothly. Delivery was quick at the time I needed it most. Setup was a snap as was breakdown and return.”