The consent form or “AOB” (Authorization of Benefits) is a document that Medical Supply Inc. (MSI) is required to have on file to stay in compliance with DME Supplier Standards. The AOB is explained in detail to a consumer when they initiate services with our company. The form says “Authorization for Release of Information” at the top and has the consumers name and identifying insurance factor on it as well.

This form authorizes MSI to bill the consumer’s insurance company for rendered services; and to release the patient’s privacy information (if need be) to insurance companies, doctor’s offices,etc.

By signing the form the patient avoids any delays in the future services and agrees to all of the following:

  • The patient understands that they have the right to access their health information at any time, and that they have the right to request MSI amend any health information that they are given.
  • The patient understands that at any time they have the right to restrict or revoke their consent by contracting MSI.
  • The patient understands that they are aware that MSI will bill them for any deductible and co-payment charges on equipment (if any).
  • The patient understands that if any item was to be denied by the insurance companies it would be noted on the form by a representative at MSI. Furthermore, the patient guarantees payment to MSI if any charges are not covered through the insurance.


The consent form is required, in order for our company to stay in compliance with DME Supplier Standards. The primary reasons we need to obtain the consent form are listed below:

  • To authorize our company to bill the patient’s insurance company for service rendered.
  • To avoid any delays in the patient’s future services.

The consumer cannot receive another order from MSI unless we have the consent form on file.

When and why do we follow up on consumers regarding AOB?

Before the first order goes out each month,CSRs review the consent form and its importance with the patient. After the order was delivered CSR’s should then follow up with the consumer to ensure that the consent form is sent back in a timely fashion. As a courtesy, CSRs should NOT contact the consumer regarding the consent form until the patient has had the order in their possession for 2 DAYS.

  • To know the status of the consent form
    • (Ex: Consumer mailed it last week, consumer misplaced it, etc.)
  • Inform the patient of the reasons why we need the consent form back.
    • That they cannot receive another order until the consent form is received.
    • We cannot bill the insurance company for their supplies, until the consent form is received.

BEFORE making the follow up call to the consumer, the representative should complete the following steps:

  • Pull the consumer up by their customer ID number.
  • Check on the status of the consent form.
  • ALWAYS read the notes before calling the consumer

Whenever a representative creates a note in the system concerning the consent form they should follow the guidelines listed below:

  • CALLER: Who you spoke with
  • NOTE: What happened on the call
    • Ex: the consumer mailed it 5/6