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Get Your Orthotics Covered By Insurance With These Easy Steps

Babafemi Adebajo
By Babafemi Adebajo
Kirsty Mac Dougall
Reviewed by Kirsty Macdougall

Published July 29, 2022.

One blue and one black  insole on pink background

Orthotics are custom-fitted inserts designed to cushion and support the foot while redistributing energy during motion. They limit excess movement and realign foot joints when standing or walking. Orthotics are prescribed to treat different foot conditions, including diabetic neuropathy, plantar fasciitis, Achilles tendonitis, overpronation, and many others.

Orthotics are made by a podiatrist who conducts a foot evaluation so the orthotic can be custom-fitted to the foot. Where a physical assessment is not possible, the podiatrist can send a foot impression kit.

Orthotics come at a cost, usually between $200 and $800. While they are effective, they are pricey, especially custom orthotics.

Does Insurance Cover Orthotics?

Fortunately, you can get partial or full reimbursement for what you spend on orthotics.

Many health benefit plans include coverage for specific medical conditions and treatments, including orthotics. These plans provide either partial or complete coverage for custom orthotics obtained with a doctor’s prescription.

It’s always best to check the specific details of an insurance plan to understand its limitations and just how much coverage it will give you. Only then should you choose an insurance plan, especially when obtaining coverage for orthotics.

What Is Required for Insurance Coverage for Orthotics?

Orthotics can eliminate the need for long-term dependency on medication, physical therapy, or surgery. Consequently, many insurance plans consider orthotics as therapeutic medical devices and provide coverage.

For example, the Flexible Savings Account (FSA) provides full insurance coverage. Others like Medicare pay 80% of the cost while you have to cover the rest. However, the specific requirements for insurance coverage for orthotics depend on your health benefit plan.

Generally, orthotics are covered if:

  • They are considered medically necessary and prescribed to treat a diagnosed medical condition covered under the health benefit plan.
  • The orthotics are prescribed by a qualified medical practitioner for protection, support, pain relief, and body alignment.
  • The insurance contract specifically covers orthotics.
  • They are made from the appropriate material, which is often pre-specified in your plan.

You can check your health benefits package on your insurance provider's website to find out the specifics of their coverage based on your package. For instance, with the FSA and Health Reimbursement Arrangements (HRA), you are eligible for reimbursement when you pay for orthotics and insoles out of pocket.

So, you can use the FSA or HRA to buy custom orthotics whenever you buy an insole, as long as you have an active account. All you need to do is provide the purchase receipt on request. The type of orthotic and its price, quality, and material don't matter as long as you can present the receipt showing your payment details.

How to Get Covered by Insurance

To get insurance coverage for your orthotics, you naturally need to be covered by a health benefits plan.

The following steps are involved in this process:

  • First, you have to research different plans and what they cover. Ideally, you want to choose a plan that provides coverage for custom orthotics. You also want to find how many orthotics your plan covers per year.
  • Then you'll need to select the most suitable insurance provider to factor in details about premiums, claims verification, etc.
  • You should get underwritten to determine your baselines and be eligible to receive coverage for some medical expenses. If your provider isn’t satisfied with your baselines, they may send you a new quote with a higher premium to pay.
  • It’s best that you confirm the specifics of your insurance plan with your insurance provider.
  • Lastly, you’ll need to choose your beneficiaries and begin paying your premiums based on your pre-specified agreement.

The following are usually necessary to get your orthotics covered by insurance:

  • A diagnosis from a podiatrist or foot care specialist
  • A prescription for a custom orthotic from a qualified professional
  • A description of the raw materials used to make the orthotics
  • Details about the casting method
  • A biomechanical gait analysis report
  • A list of dates for the foot exam
  • The orthotics order date
  • A transaction receipt or payment evidence

Apart from the first two items that the medical practitioner provides, custom orthotic providers like Upstep will make the rest available on demand if you are looking to buy custom orthotics online. Ensure you tender a request upon purchase of your orthotics.

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