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Biliblankets Delivery Qualification Form

Complete our Quick Qualification Form

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    Customer Information

    Date Of Birth

    Primary Insurance Information

    Attach a photo of your Insurance or Medicaid Card

    Secondary Insurance Coverage.

    Attach a photo of your Insurance or Medicaid Card

    Tell Us More About Yourself

    Have You Been Diagnosed With Jaundice?
    Do You Currently Have A Biliblanket ?
    I Authorize PediaCare To Contact Me By Phone, Email Or Text. PediaCare Will Not Share Or Distribute This Information. By Checking This Box, I Confirm That I Have Not Received Biliblankets Delivery From Another Provider In The Last Three Months.

    Get A Biliblankets In 3 Simple Steps

    Complete PediaCare’s Quick Qualification Form.

    Your dedicated PedicaCare Medical Specialist contacts your insurance provider and doctor to verify coverage and submits required paperwork.

    PedicaCare Med will set you up with the best Biliblankets to fit your specific needs. We will also remind you when it’s time to reorder your Biliblankets supplies so you’ll never forget.

    Congrats! Your Biliblankets and supplies will be shipped straight to your front door!

    Auto-Ship

    We will automatically ship fresh supplies to you on a schedule recommended by most Nebulizer experts, manufacturers and insurance companies.

    Courtesy Contact

    We will call or email you when you are eligible to see if you are ready to Refresh your supplies.

    Resupply

    Once you sign up with a DME to receive equipment through insurance such as a PAP machine, breast pump, or incontinence supplies, you may notice an option to join a resupply program.

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