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Eyegaze Inc. works with Medicare, Medicaid and private insurance. Navigating insurance can be confusing and frustrating, so we have a dedicated advocate on hand to help.
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Finding the Right Insurance Provider

There are many different insurance providers who all offer different levels of coverage. These are also different from plans that may be offered through your employer or state-specific Medicaid.

We can help you find the best source of funding. To begin making inquiries, we need to get an accurate estimate of your financial responsibility to purchase a device.

Potential Sources of Funding




Private Insurance


Step-by-Step Funding Request Process


Fill out authorization forms

Please complete and return the following documents to Eyegaze Inc. for specific plan benefits.

Click on each document to the right to open it in a new window.


Complete the financial responsibility form

Please complete and return this form to our office via fax: (703) 385-7137

Submit medical forms

Regardless of which insurance provider you have, you will need to submit the following documents. Complete and forward them to Eyegaze Inc.

SLP Report
A communication evaluation by a speech-langauge pathologist needs to document the need for a communication device.

Physician Prescription
Physicians must provide a DME (durable medical equipment) prescription along with clinical notes from the patient’s most recent face-to-face visit. The face-to-face visit with a physician must pre-date the physicians DME prescription form.

Note: In some instances, insurance companies require a Prior Authorization before the purchase of a Speech Generating Device, and these medical documents will need to be forwarded to the clinical department as well.


Include a copy of your insurance card

Please make a clear copy of your insurance card both front and back and include with your submitted documents.

Insurance card (front and back)


Retain for your records

Keep these documents on hand for your records.

  • Privacy Practices
  • DMEPOS Standards

How to Submit Required Documents

Send all completed paperwork to Eyegaze Inc. via fax or mail.

Mailing Address

Eyegaze Inc.
Funding Dept.
10363 Democracy Lane
Fairfax, VA 22030

Fax Number

(703) 385-7137

Easy to use, accurate, and trustworthy

Learn why the Eyegaze Edge® is the eye-tracking device of choice