it all depends on the insurance, when i got mine my dr office and insurance just delt with it and all i had to do was sign for it when it got here, Hil Rom will send out a rep to "teach you how to use your vest" when you get it and that will take about an hour, make sure you use it religously for the first year because the insurance likes to randomly call you to ask how many hours are on it to make sure you aren't "wasting their money" but after a year that goes away. At least this is how it worked for me, i dunno about everyone else, overall hil rom is easy to communicate with and other than the fact that the dang thing costs $16,000 its great, i would recomend one to anyone you just gotta figure out the best way for you to get stuff up with it so if it doesn't seem to be all that great when you get it play with the settings till you figure out the best for you, best of luck getting it, you will love it