Comparing Custom Orthotics and Off-The-Shelf Insoles
When it comes to insurance coverage, no two policies are exactly the same. With dozens of insurance providers delivering various levels of coverage at different rates, deciphering your coverage can be tricky. To help our patients better understand their coverage, we’ve compiled a list of frequently asked questions:
Are Orthotics covered by my insurance? Most insurance companies cover some, if not all of the cost of orthotics when they are deemed medically necessary. Some plans may also cover Orthopaedic shoes, bracing, and compression garments, as needed. It is best to call you insurance company or check their website to note the coverage that is available to you. Only the plan member and covered dependants are able to access the details of your coverage, we are not able to request those details on your behalf.
What are the requirements for my insurance coverage?
Although individual plans vary, most plans require a combination or all of the following to be submitted:
- a prescription for custom orthotics from a recognized prescriber outlined in your plan
- a detailed invoice
- personalized biomechanical and gait analysis
- details pertaining to the manufacturing process
As Canadian Certified Pedorthists, our SoleScience Pedorthists are dispensers of custom orthotics and will provide you with a detailed invoice at your pick up, as well as the other paperwork required by your insurer for coverage.
What’s the difference between Calendar year and Year-to-date coverage? Calendar year coverage provides coverage between January 1 and December 31 of any given year. Year-to-date insurance requires 12 full months to elapse before a renewal can be claimed. For example, if you purchased your orthotics on July 14, 2016 and have year-to-date insurance, you will not be eligible to submit a claim for another pair until July 15, 2017.
Which providers are covered by my insurance? With most major insurance companies, custom orthotics made by a Canadian Certified Pedorthist, Chiropodist or Podiatrist are covered. Some (but not all) insurance companies also cover orthotics made by a Chiropractor. In all cases, the orthotics must be custom made using a cast (mould) of your foot.
Do I need a doctor’s note? Yes, all major insurance companies require a prescription be submitted with each claim for orthotics.
- Depending on the insurance provider, the prescription may need to be written by any of the following clinicians: Medical Doctor, Orthopaedic Surgeon, Podiatrist, Chiropodist or Nurse Practitioner. Check your plan for details on who can provide your prescription.
- You do not need to have your prescription prior to your initial appointment with your SoleScience Pedorthist, however, you prescription must be written prior to your pickup appointment in order to ensure coverage by your insurer.
- Prescribed medical devices are tax exempt, meaning that with the prescription you will not be charged tax on the prescribed item.
Still have more questions? Contact us today for more information.
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