The Liberator Ostomy Supply-Care Program works with Medicare, Medicaid and a wide range of private insurance providers. To qualify for the Ostomy Supply-Care Program, verify your insurance coverage and simply fill out and submit the form below. Or call 1-866-643-3953. An Ostomy Supply-Care specialist will call you to discuss your preferred and recomendded ostomy supplies and insurance reimbursement questions. Please be assured that we value and respect your privacy. All information is strictly confidential, secure and private. To review our privacy policy click here.

Insurance Forms

Providing you with the absolute best service and support is our first priority. We look forward to the opportunity to prove to you that we are the ideal resource for your healthcare at home. Help us speed up your order by signing and returning the Assignment of Benefits & HIPPA and the Authorization for Disclosure forms.

Assignments of Benefits and HIPPA

Authorization for Disclosure