ASSIGNMENT OF BENEFITS

Before we ship your product(s), we need you to authorize the Blue Goose Network of DME Suppliers Medequip, to provide products or services that were rendered and submit claims to your insurance company on your behalf.

I also authorize the Blue Goose Partners Network to request on my behalf all insurance information, prescriptions, benefits for products provided as well as to release my medical records to any person, organization, company and/or agency which may be involved in providing my care.

Blue Goose Partners Information

Blue Goose Partners
650 Ritchie Hwy #208
Severna Park, MD 21146