To Order the
GeeWhiz® Condom Catheter Male Urinary
Incontinence Product
| Price: |
For first time users of the GeeWhiz® Condom Catheter, we recommend that you begin with a Starter Pak, which includes:
A Starter Pak costs $99.00,
plus $7.50 shipping and handling. |
| To Order By Fax: |
Go to the Fax Order Form Here |
| To Order By Phone: |
Call 1 (800) 639.9323 |
| To Order Online: |
Go to the Online Order form Here |
If you have Medicare, the following is a list of requirements for
coverage:
Doctor's prescription with "GeeWhiz® External Male Catheter" as the
prescribed item and "urinary incontinence" as the diagnosis.
Merlin Technologies, Inc. cannot accept assignment from Health
Maintenance Organizations (i.e. Kaiser Permanente, HealthNet, etc.) at
this time. Any HMO subscribers must pay for any supplies or
services they receive.
Merlin Technologies, Inc. must have the original prescription or a Faxed
copy before any billing may be done, as well as a signed copy of the
Medicare Billing Authorization (See below).
- A signed copy of the
Medicare Billing authorization form. Click on the link to obtain a copy. This file is
an Adobe PDF; if you do not have Acrobat Reader, a free downloadable
copy is available at:
http://www.adobe.com/products/acrobat/readstep.html
Read this form and print it out. Sign it and mail it to us. - A clean, easily readable
copy of all insurance cards (fax or copy is acceptable).
The following information is also required:
- Full name
- Home address, city, state and zip code
- Phone number (area code and number)
- Date of birth
All original documents (with the exception of insurance cards) must be
mailed to Merlin Technologies with a Medicare order. Faxes
will be accepted. For any questions call (800) 639.9323.
Note: Merlin Technologies will bill Medicare for qualified patients on a "non-assigned" basis, where Medicare will reimburse the patient directly.