At LC Technologies, Inc., we know that navigating the various channels of insurance can be confusing and frustrating. 
Listed below are some tools that may help.

If you need assistance getting started, have questions along the way, or are ready to submit a claim, please contact Nancy Roepke, who is responsible for working with Medicare, Medicaid, private insurance companies and other funding sources to facilitate the lease and/or purchase of the Eyegaze Edge for persons with disabilities.

Nancy Roepke

Funding Manager
3919 Old Lee Highway
Suite 81B
Fairfax, VA 22030
Phone: (703) 385-7133 Fax: (703) 385-7137
E-mail: ins0309@eyegaze.com

Please contact Nancy for samples of the required documentation.

Whether you file a claim or we file it on your behalf, there are basic items of documentation that all insurers will require.

• completed insurance claim form
• comprehensive written evaluation by a speech-language pathologist (SLP)
• physican's signature on SLP report indicating agreement with the evaluation
• prescription from physician for "Eyegaze Edge communication system"
• detailed price quote or copy of lease or purchase contract, whichever is applicable
• Eyegaze Edge brochure / Medicare price sheet

Other documentation may be required, depending upon the insurer. Additional items you may want to include to strengthen your case might include:

• a cover letter
• a brief (2 minutes) video of the user actually using the Eyegaze Edge and/or a photo of the client using the Eyegaze Edge
• letters of support from caregivers, family, friends, other healthcare workers (i.e. physical therapist)
• progress notes from physician describing: 1) what led to the diagnosis and 2) why the patient now needs the Eyegaze Edge

If you would like LC Technologies to assist you in the process of obtaining funding, please read our Notice of Privacy Practices and complete and return to us the forms listed below. 

PLEASE NOTE:  SEND FORMS TO ADDRESS ABOVE

   Notice of Privacy Practices (PDF File)
   User Insurance Form (PDF File)
   Authorization for Release of Information Form (PDF File)
   Assignment of Benefits Form (PDF File)

Medicare-Compliant Eyegaze Edge pricing information
 
Medicare DME Supplier Standards