Information and Qualifications
For Courtesy Billing
To Medicare and Other Insurances

Courtesy Billing
As you know Medicare and other health insurances may reimburse for medical equipment and supplies. Freedom2Go will conduct courtesy billing for all customers with the required medical necessity documentation. Courtesy billing is also known as billing a non-assigned claim(s). The Medicare beneficiary or other insurance policy holder is responsible for payment at the time of service, and any reimbursement from the insurance(s) will be paid directly to the policy holder. Please be advised there is no guarantee of payment upon Freedom2Go filing a courtesy claim; however, we will be glad to fill a courtesy claim on your behalf .

Prescriptions and Certificates of Medical Necessity (CMN)
Prior to filing the claims, Medicare and other insurances require a qualifying prescription or a special form called a CMN (Certificate of Medical Necessity) to be completed by your treating physician. At the time of your request for courtesy billing, we will ask you for a copy of your prescription or CMN (Certificate of Medical Necessity). If you do not have the required forms we will be glad to e-mail them to you. Please print these forms and take them to you physician for completion. After your physician has completed the forms, you or your physician will need to fax or mail them to us. Our fax number is (325) 437-1581 and the mailing address is Freedom2Go, LLC, Attn: Web-Site Sales, P.O. Box 2802, Abilene TX 79604-2802. We can also accept a scanned copy of the forms if your computer system has the ability. Please e-mail the scanned copy to sales@freedom2go.com.

Prescriptions and State Sales Tax
If you present us with a prescription signed by your treating physician for your medical supplies or equipment then we can process you order without having to collect state sales tax.

Advance Beneficiary Notice (ABN)
When Freedom2Go files non-assigned claims on the behalf of our customers who are Medicare Beneficiaries, we are required to obtain an Advance Beneficiary Notice (ABN). The ABN is required as a notice of possible denial of your claim by Medicare and by signing the ABN it is a statement of acknowledgement. You will receive a copy of the ABN that provides you with possible denial reasons via e-mail from our sales department. Please print a copy, review the content, and sign where indicated. The ABN will need to be returned to Freedom2Go via fax or mail. Our fax number is (325) 437-1581 and the mailing address is Freedom2Go, LLC, Attn: Web-Site Sales, P.O. Box 2802, Abilene TX 79604-2802. We can also accept a scanned copy of the forms if your computer system has the ability. Please e-mail the scanned copy to sales@freedom2go.com. We must have the completed Advance Beneficiary Notice (ABN) returned prior to shipment of your order if you choose courtesy billing.

Privacy Statement (HIPAA Release Form)
All medical providers are required to have a privacy statement on file for each customer who has given any patient health information. The form states Freedom2Go is not allow to release any of the information unless instructed by the customer in writing. This form also Freedom2go to send the necessary documentation along with the insurance claim form when providing courtesy billing. You will receive a copy of the privacy statement via e-mail from our sales department. Please print a copy, review the content, and sign in designated area. This form will need to be returned via fax or e-mail. Our fax number is (325) 437-1581 and the mailing address is Freedom2Go, LLC, Attn: Web-Site Sales, P.O. Box 2802, Abilene TX 79604-2802. We can also accept a scanned copy of the forms if your computer system has the ability. Please e-mail the scanned copy to sales@freedom2go.com.

Payment Details
Medicare and most insurance have specific allowances for each type of equipment. If Medicare or your insurance deems your claim medically necessary and qualifies for reimbursement, the payment will be based on the allowable. Medicare will reimburse 80% of the allowable to the Beneficiary. Medicare also has $110.00 annual deductible which is renewed every January. Other insurances will determine benefits based on your specific plan and reimburse directly to the policy holder. Other insurances may have an annual deductible which may apply to your claim. If you should have any questions regarding your medical insurance policy please contact them directly.

Courtesy Billing Forms
If you would like to print out the form needed for us to process your courtesy billing request, please click here.