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Order Form / Condition of Sale

How to Submit Your Order

Insurance coverage for our products is available from most Health Insurance Carriers under "Durable Medical Equipment." Your coverage is dependent on your specific plan. Our trained staff can assist you in determining your benefits and filing your claim. The following items are needed:

1. A prescription from your physician.

2. The Richmond Light Company Order Form and a signed Condition of Sale Form.

3. A "letter of necessity" written by your physician. It should state that you are a good candidate for UV phototherapy, which represents a medical and fiscally efficient treatment for your skin condition. Most physicians who regularly prescribe home phototherapy have these letters available. Should you or your physician need representative samples, please let us know.

4. Any medical records showing your current treatment is recurrent and expensive, thus demonstrating that home phototherapy is a cost-effective option. This may be required by your insurance carrier for maximum benefit coverage, and is normally sent directly by your physician's office.

5. Preauthorization for purchase of the unit from your Health Insurance Carrier. Some insurance plans require that your physician obtain the preauthorization on your behalf.

6. Written determination of your benefits related to this purchase. You must call your insurance carrier or benefits office to determine your coverage and co-payment. The Richmond Light Company will need an insurance carrier contact person and phone number to coordinate your benefits.

You are now ready to place your order. Mail or fax the prescription along with the Order Form and Condition of Sale Form to The Richmond Light Company. Medicare recipients should also send the "letter of necessity."

Qualified Medicare recipients are reimbursed directly; therefore, it will be necessary for you to pay The Richmond Light Company prior to shipment. Be sure to complete the Medicare information requested on our Order Form. We will submit the necessary forms to Medicare.

Please note: You must obtain a "preauthorization" from your insurance carrier prior to purchasing the unit. If you fail to get this authorization, many carriers will automatically deny your claim.

All financial arrangements must be made prior to the unit being released for shipment.