SAVINGS PROGRAM
For
COMMERCIALLY
Insured Patients
You can use your savings card by contacting Inverse Medical, Inc.
before the calendar year ends, you will receive information
and eligibility requirements for continued participation in the program.
$0 CO-PAY EVERY MONTH*
*$75 maximum program benefit per calendar year.
No monthly cap.
Not Valid for patients using Medicare, Medicare Part B, or Medicaid.
See eligibility requirements on next page.
Get instant savings on your deductible,
co-pay, and co-insurance costs for medical devices.
AM I ELIGIBLE?
You may be eligible for the Savings Program if you:
• Are being treated for an approved Indication for Use for medical devices.
• Currently use Private or Commercial Health Insurance that covers a portion of medical device costs for
Inverse™ medical devices.
OTHER REQUIREMENTS:
• This offer may not be combined with any other coupon, discount, prescription savings card, free trial, or other offer.
• This program is only available to individuals using Private or Commercial Health Insurance to cover a portion of their
medical device costs, including plans available through State and Federal healthcare exchanges. This program is not
available to individuals who use any State or Federal government-subsidized healthcare program to cover a portion of
device costs, such as Medicare, Medicaid, TRICARE, Department of Defense, or Veterans Administration. Patients
confirm they will not seek reimbursement from any of these programs or from provider patient assistance foundations
and accounts such as a Flexible Spending Account (FSA), Health Savings Account (HSA), or Health Reimbursement
Account (HRA).
• Offer valid only in United States and Puerto Rico. Inverse Medical, Inc., reserves the right to rescind, revoke, or amend
this offer without notice at any time. Void where prohibited, taxed, or otherwise restricted by law.
• Offer for new enrollment expires December 31, 2018. For Massachusetts residents only, this offer is subject to change
per state legislation.
• Before you activate your card, it is important you understand you will be asked to provide personal that
may include your name, address, phone number, email address, and information related to your prescription
insurance and treatment. This information is necessary to permit Inverse Medical, Inc., the provider of medical devices
and companies that work with Inverse Medical, Inc., including affiliates and service providers, to fulfill your request
to enroll in the Inverse™ DevicePath™ Savings Program. We may also use the information you give to learn more about
the people who use medical devices and to improve the information we provide to those being treated with
medical devices from Inverse Medical, Inc. We will not share your information with anyone except as required by law.
• As a condition of participating in this program, you must ensure you comply with any co-payment disclosure
requirements of your insurance carrier or third-party payer, including disclosing to your insurer the amount of
co-payment support you receive from this program.
• The selling, purchasing, trading, or counterfeiting of this card is prohibited.
Inverse™ DevicePath™ is in no way an extension of medical treatment provided by healthcare professionals
to individual patients. You may discontinue your participation at any time by calling (844) 309-2542.