PureWick referral resources — download the authorization form or request a provider specialist
For Urologists & Case Managers
Refer a patient for PureWick in minutes.
RA Fischer Co. is an authorized PureWick DME supplier. We handle Medicare authorization, insurance verification, and monthly refill coordination — so your patients get set up without adding work to your practice.
75+
years as a DME supplier
30
wicks covered monthly
1 fax
to get your patient started
Authorized PureWick DME Supplier
Medicare Part B · Medicare Advantage · Private Insurance
Serving patients & providers since 1948 · Moorpark, CA
Why providers choose us
We make PureWick referrals easy to manage at scale.
Once a patient is referred, RA Fischer takes over. Providers tell us it reduces the administrative follow-up they'd otherwise do themselves.
Send the paperwork, we review and verify
Send us the completed PureWick authorization paperwork, and our team will review it to confirm all required documentation is included while verifying Medicare or private insurance coverage to move the referral forward.
Patient support through the process
Our team helps patients understand the process, complete required forms, and access setup guidance, written instructions, videos, or phone support if additional help is needed.
Medicare & insurance handled directly
We work directly with Medicare Part B, Medicare Advantage, and most private plans to verify eligibility. No claim-chasing for your billing team.
30
wicks covered per month for eligible patients
75+
years supplying DME to patients nationally
1 fax
is all your practice needs to start a patient
Referral process
What happens after you fax the form
Timing may vary depending on insurance requirements, documentation, and authorization timelines.
Send completed form to
(818) 775-2941
Fax · or email to insurance@rafischer.com
Include: patient name, DOB, diagnosis, insurance information, and any available chart notes
1
You fax the completed authorization form
Send the completed authorization paperwork with patient information, diagnosis, prescriber signature, and any available chart notes to (818) 775-2941. We accept fax or email to insurance@rafischer.com.
2
RA Fischer reviews documentation, verifies coverage, and coordinates next steps
Our team reviews the referral, verifies Medicare or qualifying insurance, and coordinates any needed documentation, patient forms, or prior authorization.
3
Patient support and setup resources are provided
Once the referral is approved and required documentation is complete, patients receive written instructions, videos, and setup guidance, with a Treatment Specialist available to provide additional support by phone if needed.
4
Monthly refills coordinated
For eligible patients, 30 wicks are shipped every 30 days directly to the patient. We manage refill orders and insurance reauthorization on an ongoing basis — one referral, ongoing care.
Authorization forms
Download or complete the PureWick authorization form
Choose the option that works best for your practice workflow.
PureWick™
PureWick Authorization Form
Authorization form for the PureWick™ Urine Collection System and monthly wick refills. Complete with patient information, diagnosis, and prescriber signature, then fax to (818) 775-2941.
Need the Iontophoresis Packet?
Referring a hyperhidrosis patient instead?
The Iontophoresis Insurance & Physician Packet is available on our hyperhidrosis provider page — including a fillable online version.
Go to Iontophoresis Provider Page →
Administrative support
Everything we take off your plate.
Providers refer patients to RA Fischer because we eliminate the follow-up work that typically falls back on the practice or case manager.
Prior authorization submission
We submit PA requests to Medicare and private insurers directly — no coordination required from your billing team.
Insurance eligibility verification
We contact the patient and verify their specific plan coverage before any supplies ship.
Monthly refill coordination
30 wicks shipped every 30 days. We manage the refill schedule and handle insurance reauthorization on an ongoing basis.
Patient & caregiver education
Treatment Specialists walk patients and caregivers through setup and proper use — reducing callbacks to your office about device questions.
FAQ
Provider questions, answered.
Common questions from urologists, urogynecologists, case managers, and VA providers.
(800) 525-3467Complete the PureWick Authorization Form (available above) and fax it to (818) 775-2941, or email it to insurance@rafischer.com. Include the patient's name, date of birth, diagnosis, and insurance information. Once received, we contact the patient directly and handle everything from there.
A dedicated Treatment Specialist is assigned to your patient. They verify coverage, obtain prior authorization from the insurer, coordinate the initial supply shipment, and educate the patient and caregiver on proper use of the PureWick system. You do not need to follow up — we handle the full process and reach out if we need anything additional.
Yes. We work with Medicare Part B and Medicare Advantage plans to provide coverage for the PureWick system and monthly refills. We also work with most major private insurance plans. We handle prior authorization and claim submissions directly — no work required from your practice's billing team.
Yes. We work with Tricare directly for eligible patients. For VA facilities, each location follows its own procurement process — to coordinate and get RA Fischer added to your provider list, contact our insurance team at insurance@rafischer.com. VA purchase orders can be faxed to (818) 775-2941.
Prior authorization timing varies depending on the insurance plan, documentation requirements, and how quickly any requested information is completed. Once RA Fischer receives the referral, our team reviews the paperwork and helps coordinate the insurance and documentation steps needed to move the patient forward.
Yes. Facilities and case management offices can place orders directly. Contact us at (800) 525-3467 or email info@rafischer.com to discuss facility ordering options and volume supply coordination.
Yes. Our Treatment Specialists can supply patient education materials about the PureWick system, including setup guides, usage instructions, and information about insurance coverage. Contact us to request materials for your office or to have them sent directly to a referred patient.
Become a referring practice
Get a dedicated Treatment Specialist assigned to your practice.
For case managers and practices that refer patients regularly, we can assign a named RA Fischer Treatment Specialist as your practice's contact — someone who knows your workflow and can prioritize your referrals.
01
A named specialist for your practice
One point of contact for all your PureWick referrals — no rotating support teams, no repeating yourself.
02
Support for established referring practices
Practices that refer regularly can work with our team to streamline new patient referrals.
03
Patient status updates on request
Your specialist can provide status updates on referred patients so you know when they're set up and receiving supplies.
Request a Provider Specialist
Tell us about your practice, and a member of the RA Fischer team will follow up to answer questions and help you understand the referral process.
Also referring hyperhidrosis patients?
The Fischer iontophoresis device is available through RA Fischer with insurance support for dermatology and primary care referrals.