Obalon Weight Loss Challenge Rebate Program
Terms and Conditions
Obalon Weight Loss Challenge is a rebate program that works by providing you (the patient) up to a $1,000 mail-in rebate from Obalon and a $500 instant rebate from your physician with a total possible rebate of $1,500 for one (1) treatment with the Obalon Balloon System by your treating physician. All qualifying, eligible patients will receive a $500 instant rebate, from eligible, participating physicians. Patients losing 25-39.9 pounds will be eligible for an additional $500 mail-in rebate ($1,000 total rebate from the cost of treatment). Patients losing 40 or more pounds will be eligible for an additional $1,000 mail-in rebate ($1,500 total rebate from the cost of treatment). To qualify for this offer, you must properly complete a redemption form (also available via Obalon’s authorized website at Obalon.com/rebate-form) and receive a coupon code. You must further agree to all stated disclosures and waivers, print the submission form and bring it into your treating physician for redemption. Obalon Balloons used in your treatment must be purchased legally in the U.S. and administered in accordance with a valid prescription by a licensed physician. For eligibility, initial balloon placement must occur between July 1 and August 31, 2018. Submission forms must be provided to your treating physician and the coupon code entered into the Obalon Commercial Registry (“Registry”) by your physician at the time of your initial balloon placement. Total weight lost will be determined, by your physician, at the time of final balloon removal (after full 3-balloon treatment and at least 140 days after first balloon placement) and entered, by your physician, into the Registry. Exceptions on the minimum treatment time or the number of balloons must be submitted by your physician to Obalon for review. Final balloon removal and entry into the Registry must occur within 195 days after initial balloon placement. Please allow 6-8 weeks after final balloon removal and Registry entry for processing. If you have questions about this offer, please call toll free 1-844-3OBALON (844-362-2566). No submissions will be considered after August 31, 2018, and no rebates processed after March 15, 2019.
You must be 18 years of age or older to be eligible. Patient, pharmacist, and prescriber agree not to seek reimbursement for all or any part of the benefit received by the patient through the offer. You are eligible for this offer only if you paid for your entire treatment yourself and if no part of your treatment was covered by insurance or another third-party payor. You are not eligible for this offer if your private insurance, HMO, or other health benefit program paid for all or part of your treatment. If any form of reimbursement is sought from a third-party, you may be required to disclose the value of this rebate to that party or entity. This offer is available only to qualifying patients, excluding claims from Obalon employees and their spouses. This offer is non-transferable. No substitutions are permitted. No membership fees are associated with this offer. Offer valid only in the U.S., from participating physicians. Void where prohibited by law, taxed, or restricted. For a listing of participating physicians, visit Obalon.com.
This offer is limited to one redemption per person and cannot be combined with any other Obalon offer or promotion. No other purchase is necessary. This rebate is not insurance. By submitting a rebate request, you agree to all terms and conditions of this offer. Obalon reserves the right to cancel or modify this offer without notice. All rebate requests become the property of Obalon and will not be returned. Obalon assumes no responsibility for lost, late, damaged, misdirected, misaddressed or incomplete requests that fail to be properly delivered for any reason. Rebate checks will be issued in U.S. dollars only. Rebate checks are void if not cashed or used within 180 days. It is illegal to sell, purchase, trade, or counterfeit, or offer to sell, purchase, trade, or counterfeit the rebate check.
Indication and Important Safety Information:
The Obalon Balloon System (the “System”) is an FDA-approved, prescription-only treatment to facilitate weight loss. Individual weight loss results will vary. The System is a swallowable intragastric balloon system indicated for temporary use to facilitate weight loss in adults with obesity (BMI of 30 – 40 kg/m2) who have failed to lose weight through diet and exercise. The System is intended to be used as an adjunct to a moderate intensity diet and behavior modification program. All balloons must be removed in 6 months. Talk to your doctor if you have any questions about the System including any possible side effects. Patients with prior weight loss surgeries, inflammatory or other pathophysiological conditions of the GI tract are not eligible. The most common side effects reported were mild abdominal pain and nausea which typically resolved within two weeks. You must take daily acid-blocking medicine prescribed by your doctor. For full Important Safety Information click on Safety Information and Patient Labeling, available at Obalon.com/safety-information.