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Vacuum Therapy

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We make this as simple as possible by providing you all the important information. After you fill out our intake form and provide us with your information we get the ball rolling by verifying your insurance and contacting your physician. After all is verified we'll will follow up with you and ship the products you requested right to your door.

Any information provided is encrypted and secure! OnlineMedSupplies.com, A Division of Centreville Medical Arts DME has developed this Privacy Policy for the benefit of each user of this website to demonstrate our serious commitment to protecting your privacy.

You may also contact your Personal Patient Advocate and provide the required information via phone or fill out our short contact form and we'll contact you. Our Personal Patient Advocates are available from Monday through Friday 9:00am to 6:00pm, EST.

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Medicare / Insurance Inquiry

Both Medicare as well as Insurance Providers require the following information. By providing this information you help shorten the process of verifying your benefits and completing the purchase. Please be advised that providing this information does not obligate you to purchase any products. Once we have verified your information we will contact you so that you can make a decision. If you have any questions regarding our Privacy Policy please click here.

We will contact your physician and will need to obtain a copy of the progress notes from the last three office visits to your physician that pertained to the condition that the product will treat.

*Generally, you pay 20% of the Medicare-approved amount after you pay your Medicare Part B deductible for the year ($162 in 2011). Medicare pays the other 80%. The Medicare-approved amount is the lower of the actual charge for the item or the fee Medicare sets for the item. However, the amount you pay may vary because Medicare pays for different kinds of durable medical equipment in different ways. You may be able to rent or buy the equipment.

Please provide your information below

First Name:		Last Name:
Date of Birth:		Gender:
Address:		State:
Zip:		Home Phone:
Cell Phone:		Email Address:

Is Medicare you primary insurance?	Yes No	If not, who is your primary insurance?
Medicare/Insurance policy number:		Group Number:
Phone Number:
Do you have secondary insurance?	Yes No	Sec. Ins. Company:
Policy Number:		Group Number:
Phone Number:

By clicking below to agree I agree to go back to my doctor in approximately 6 weeks for re-evaluation. I acknowledge that I will be responsible for returning or purchasing the unit if I do not return to my doctor. YES, I agree:

Physician's Name:
Address:		City:
State:		Zip:
Phone:		Email:
May we contact your doctor on your behalf for the prescription?		Yes No
May we contact your doctor on your behalf for your Medicare/Insurance information?		Yes No

Please contact your doctor's office to let them know that OnlineMedSupplies.com, a division Centreville Medical Arts DME, will be sending them information so your doctor can better serve you!
Products interested in:
Electrotherapy	Back Braces	Vacuum Therapy


I agree with the Privacy Statement/Terms: Your initials:
One last VERY IMPORTANT question! We want to make sure we thank any referring doctors/customers & partners. How did you hear about us? (If you found us online, please let us know if you found us on Google, Yahoo!, Bing, or another website!)

Medicare LCD (Local Coverage Determination) Information

"For chronic pain, the medical record must document the location of the pain, the duration of time the patient has had the pain, and the presumed etiology of the pain. The pain must have been present for at least three months. Other appropriate treatment modalities must have been tried and failed, and the medical record must document what treatment modalities have been used. The presumed etiology of the pain must be a type that is accepted as responding to TENS therapy. Examples of conditions for which a TENS unit are not considered to be medically necessary are (not all-inclusive): headache, visceral abdominal pain, pelvic pain, and temporomandibular joint (TMJ) pain."

The LCD is the official Medicare Jurisdiction C regulation.

This information is intended as a patient education resource only and should not be used for diagnosing or treating a health problem as it is not a substitute for expert professional care. If you have or suspect you may have a health problem, please consult your health care provider. In addition, every effort is made to ensure links to external sites as well as medical information and/or medical animations are current and correct.

Medicare or your health insurance may cover the entire cost of your medical supplies.* Click here to see what products are available to treat your pain.

When you inquire about any of our Neuropathy treatment products!

If your insurance card has one of the following logos on either front or back, we are a participating provider. If you cannot find any of these logos please contact us to check your eligibility!