Customer Forms

• Authorization of Billing (AOB)
• Glucose Testing Log / Glucose Testing Log - Enlarged Version

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Please remember to sign and date the form before sending it to us by fax or mail.

Frequently Asked Questions

Authorization of Billing (AOB)

Do I need to fill out an Authorization of Billing form?

Only if you have Medicare or other insurance, and you would like DiabeticSupplies.com to submit insurance claims on your behalf. Customers who only purchase non-insurance items do not need to fill out an Authorization of Billing form.

Why does DiabeticSupplies.com require this information?

We are not allowed to submit claims to Medicare or private insurance on your behalf without your explicit authorization. By completing the Authorization of Billing form, you are giving DiabeticSupplies.com authorization to submit Medicare and private insurance claims on your behalf.

When do I need to send this form?

As soon as possible - we cannot send you your testing supplies without this completed form in our files. The good news is that this form only needs to be completed once.

What if I do not wish to send you this form?

Without your authorization we cannot submit claims to Medicare or private insurance on your behalf.

Glucose Testing Log / Glucose Testing Log - Enlarged Version

Do I need to fill out a Glucose Testing Log?

Only if you have Medicare and if a Doctor's Order states you are testing more than the Medicare guidelines below, then you must provide DiabeticSupplies.com with a Glucose Testing Log once every 6 months:

• more than 1 time per day while NOT being treated with insulin, or
• more than 3 times per day while being treated with insulin

Why does DiabeticSupplies.com require this information?

Medicare has stated that it will only pay for diabetic supplies that it deems are "reasonable and necessary." If DiabeticSupplies.com is unable to provide Medicare with this information when submitting a claim, Medicare will more than likely not pay for the diabetic supplies. Medicare may pay for diabetic supplies that exceed Medicare guidelines with a Doctor's Order and with proof of testing (Glucose Testing Log).

When do I need to send this form?

DiabeticSupplies.com requires this information once every six (6) months from Medicare customers who test more than the Medicare guidelines noted above. Please return this form to DiabeticSupplies.com at least two weeks before you need your next order of diabetic supplies to allow for order processing. If you do not provide a Glucose Testing Log to DiabeticSupplies.com once every 6 months, then we will only send the lesser of your Doctor's Order or Medicare guidelines for diabetes testing supplies.