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Diabetes Management

Membership Benefits

  • No Deductibles
  • No Claim Forms
  • Free Diabetic Kit
  • No Co-Insurance
  • No Plan Premiums
  • No Cost for Shipping
  • 24-hour Nurse Hotline
  • No Out of Pocket Costs
  • Care Coordinator Service
  • No Up-Front Cost for Supplies

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Agent Benefits

  • Telemarketing Oppurtunities
  • Valued Component of our Team

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Contact Us

Telephone:1-866-866-7951
Fax:1-937-898-3202
Email Contact

75 North Dixie Drive
Vandalia, Ohio 45377
AmericanDiabetesManagement

- Diabetes Control -

Finding out you have diabetes is scary. But don't Panic. Diabetes is serious,
but people with diabetes can live long, healthy, happy lives.

What is Diabetes?
Diabetes is a serious disease. It means your blood glucose (often called blood sugar) is too high. Your blood always has some glucose in it because your body needs it for energy. But too much glucose in your blood is not good for your health.

Why should I control my Diabetes?
If you control your diabetes, it can help you feel better and stay healthy. Keeping your blood glucose close to normal lowers your chances of having heart, eye, kidney, and nerve problems. To control your diabetes, you need to know your blood glucose numbers.

Type I Diabetes
Type I diabetes is usually diagnosed in children and young adults, and was previously known as juvenile diabetes or insulin-dependent diabetes mellitus (IDDM). In type I diabetes, the body does not produce insulin. Type I diabetes may account for 5% to 10% of all diagnosed cases of diabetes. This form of diabetes usually strikes children and young adults, although disease onset can occur at any age.

Type II Diabetes
Type II is the most common form of diabetes. In type II diabetes, either the body does not produce enough insulin or the cells ignore the insulin, and was previously known as non-insulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes. Insulin is necessary for the body to be able to use sugar. Type II diabetes may account for about 90% to 95% of all diagnosed cases of diabetes. It usually begins as insulin resistance, a disorder in which the cells do not use insulin properly.

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Last Name  First Name  MI 
Bithdate     Gender F M     Phone# 
Resident Street Address 
City  State  ZIP Code 
Name Listed On Medicare Card 
Medicare Claim Number 
Effective Date Hospital (Part A) 
Effective Date Medical (Part B) 
Medicaid Claim Number 

Individual Or Group Insurance Company / Plan or Medicare
Advantage Company / Plan Information (If Applicable)

Insurance Company / Plan Carrier 
Insurance / Plan Customer ID Number 
Phone Number To Verify Benfits or Covarge  
Primary Diabetic Physician 
Physicians Address  
City  State   ZIP Code 
Physicians Phone#    Fax# 
Date Of Last Visit 
Are You Insulin Dependant Yes No
Do You Use Byetta Yes No
Do You Inject In The A.M. P.M.
Do You Use A Short Needle Long Needle
Blood Sugar Checked Time(s) Daily (Minimum Once)
Do You Have A Monitor Yes No
If Yes, What Brand Monitor 
Current Diabetic Supplier  
Date Last Received Supplies 

I authorize the release of any medical or other information necessary for MedPoint to process and submit my claims. I authorize payments for medical supplies furnished to me by MedPoint be paid directly to them.

I agree that if any insurance company sends me the payments, I will send all of the payments received directly to MedPoint as soon as I receive them. I understand my insurance payments for the supllies belong to MedPoint. I understand that using the insurance payments for anything other than paying for my supplies is against the law.

I authorize MedPoint to contact me at periodic intervals to determine my need for supplies which may be rented or purchased by me.

Full Name 
Todays Date 
City  State   ZIP Code 


DISCLAIMER: American Diabetes Management is not a Medicare Advantage Special Needs Plan. American Diabetes Management is not contracted or affiliated with The United States Federal Government or The Centers for Medicare Medicaid Services.