If you are Medicaid eligible and reside full-time in one of the states listed here, you can receive your required incontinence products at no cost to you. Delivery service and patient instruction are also provided at no cost to you. We will work directly with your physician to gather all required documentation and get the products you need.
ActivStyle meets all the requirements to bill Medicaid on your behalf.
It is important that you speak with an ActivStyle Incontinence Specialist to establish your level of need and to find the best product for you. We will ask you to provide us with certain information which will allow us to provide your incontinence supplies. To complete this form click here.
You and ActivStyle, Inc. are partners in your health care. To ensure the finest care possible, you and/or a loved one needs to be involved in your health care program. ActivStyle is accredited by ACHC which insures that you will receive the high level of service to which we have committed. Please download and read the documents available on this page to fully understand the ActivStyle program, your responsibilities and the payment coverage provided by your state Medicaid program.
ActivStyle Client Forms
To open these forms you will need the Adobe Acrobat Reader, if you do not have the reader currently installed, you may download it from Adobe.com