How Insurance Coverage Works

When you place an order with UroStat, we verify your insurance benefits and bill your insurance according to your plan’s requirements. Depending on your coverage, your insurance may pay all, some, or none of the cost of your supplies.

Because every insurance plan is different, coverage can vary even between plans offered by the same employer. UroStat cannot guarantee that an item will be covered until your insurance has processed the claim.

What Is a Deductible?

A deductible is the amount you must pay out of pocket before your insurance begins covering medical claims for the year.

For example:

• Your annual deductible is $1,000
• You’ve paid $600 toward it
• You may still be responsible for the remaining $400 before your insurance begins paying according to your benefits

Your deductible usually resets at the beginning of each new plan year.

What Is an Out-of-Pocket Maximum?

Your out-of-pocket maximum is the most you’ll pay for covered healthcare services during your plan year.

Once you reach this amount, many insurance plans begin paying 100% of covered services for the remainder of the year. Your insurance company determines this amount based on your specific plan.

If You Have Medicaid and Another Insurance

If Medicaid is your secondary insurance, UroStat cannot bill Medicaid first.

Your primary insurance must process the claim before Medicaid can be billed. Medicaid is considered the payer of last resort, meaning it generally pays only after all other available insurance has been billed.

Understanding Your Insurance Plan

Not all insurance plans provide the same coverage for medical supplies.

Your benefits may depend on:

• Your specific insurance plan
• Whether UroStat is in-network
• Your deductible status
• Medical necessity requirements
• Prior authorization requirements
• Your plan’s covered products

If you have questions about your benefits, our team is happy to explain what we’ve verified and help you understand your coverage.

Medicare Coverage

Medicare generally covers medically necessary catheters when Medicare guidelines are met.

However, Medicare and most Medicare Advantage plans do not cover incontinence supplies such as diapers or pull-ups. If Medicare denies these supplies, Medicaid typically cannot pay as a secondary payer.

Changing to UroStat

If you’re currently receiving supplies from another provider, switching is easy.

In most cases, we’ll wait until your current 30-day supply period ends before starting service. You’ll also complete a Change of Provider form so we can become your new supplier. Please reach out if you would like to start service with UroStat – here.

Need Help Paying for Your Supplies?

If you’re having difficulty affording your medical supplies, please let us know. Depending on your situation, you may qualify for:

• UroStat’s Hardship Program
• A payment plan

Our team can discuss the available options with you.

Frequently Asked Questions

Why doesn’t my employer’s insurance cover my supplies?

Coverage depends on the specific benefits included in your insurance plan. Even plans from the same employer can have different coverage levels for durable medical equipment and medical supplies.

Does it matter if I have an HMO or PPO?

Yes. HMO plans often require you to use in-network providers, while PPO plans may offer both in-network and out-of-network benefits. Your coverage depends on your individual plan.

Important Notice

Insurance coverage is never guaranteed. Every claim is reviewed according to your individual insurance benefits, medical documentation, and your plan’s coverage guidelines. Whenever possible, UroStat will always verify your benefits and help you understand your coverage before moving forward.

I think this format works much better for a patient portal because patients can first understand the concepts, then use the FAQs for specific questions, rather than being presented with a long list of questions from the start.