Will My Insurance Cover Catheters?

This is paid after your deductible and is a fixed amount that you pay for a healthcare service, such as an MD visit, Rx medication, hospital stay, ER visit, lab tests…etc

This is a cost share that you take on with your insurance provider once your deductible is met. These payments are applied towards the Out of Pocket Max.

This is an agreement that we make to pay our insurance provider a certain amount of money before the insurance plan will begin paying on a claim/claims.

The amount that the policyholder must spend on healthcare costs (through deductible, copays, or coinsurance) before the insurance begins paying all claims at 100%. The amount does not include any payments made towards plan premiums.

This is a set limit of items that insurance will pay for per dispensing period (typically Rx medication, disposable medical supplies) this delineates the maximum quantity that the insurance will reimburse for. Over this limit might require PAR (Prior Authorization Request). For example, Medicare will allow up to 200 intermittent catheters each month (200 is the maximum quantity allowed by MCR).

This term is used to describe a healthcare plan that pays a flat fee to providers for each patient the provider sees who is insured by this plan despite services rendered. In other words, under a capitated contract/insurance plan, an insurance provider pays a fixed amount of money for its members care directly to the healthcare provider despite the equipment/medication/service/supply provided, the fee is a flat rate paid per member.