Walter Hsiang, MD, discusses insurance-related barriers to kidney stone care

In the following interview, conducted at 2026 Desai Sethi Urology Institute Urology on the Beach meeting in Miami Beach, Florida, Walter R. Hsiang, MD, MBA, shared the background and key findings from the study, "Accessibility and Costs of Urologic Nephrolithiasis Care: A Contemporary National Cross-Sectional Study.”¹ Hsiang is a PGY-5 resident at the University of California, San Francisco.

Overall, the study evaluated access to care, insurance acceptance, wait times, and costs for stone disease management across outpatient urology clinics in all 50 US states. Using a “secret shopper” methodology, investigators contacted approximately 1,100 urology practices nationwide, making it one of the largest studies to directly assess real-world access to urologic care.

The analysis found that approximately 75% of urology clinics accept Medicaid—a higher rate than reported in many other surgical specialties. Further, nearly all clinics (97%) accept Medicare, suggesting continued access parity between Medicare and privately insured patients despite ongoing reimbursement pressures. However, Medicaid patients encountered significantly more barriers to care, including roughly twice the likelihood of requiring a referral from a primary care physician or emergency department before being seen by a urologist.

Cost analyses showed that the median self-pay price for an initial stone consultation was approximately $250, with substantial variation by state. Notably, nearly half of clinics offered discounts or payment plans for self-pay patients, a finding not previously well characterized in urology. The authors emphasized that patients may benefit from proactively asking about financial assistance options when scheduling appointments.

REFERENCE

1. Hsiang W. Accessibility and Costs of Urologic Nephrolithiasis Care: A Contemporary National Cross-Sectional Study. Presented at: Urology on the Beach 2026. January 16-18, 2026. Miami Beach, Florida