Are Custom Orthotics Covered By Insurance?
For many patients, a pair of custom orthotics can make a lot of sense. This medical device will provide good arch support, cushioning in all of the right places, and all the other benefits to make your feet happy and reduce the amount of pain and discomfort that you may feel on a regular basis.
While there are a lot of benefits to choosing a pair of custom orthotics, you may be worried about the cost that comes with them. As you look through the custom orthotic options available to you, it is easy to see that they will cost between $200 to $800 for a pair, based on the foot condition you want to heal, the accessories, and the features.
With this high cost, many patients worry about whether they will be able to afford this medical device to give them some relief. The good news is that many insurance plans will provide coverage for custom orthotics for patients who have a prescription for it.
Let’s take a closer look at whether custom orthotics are covered by insurance or not.
Are Custom Orthotics Covered by Insurance?
Many insurance plans are going to provide you with some coverage when you need a pair of custom orthotics for medical conditions. It will depend on the insurance plan that you have and whether you can get a prescription for the orthotic from your doctor. Not all plans will provide this coverage for you, so checking your policy will make a big difference.
When medical insurance does provide coverage for this, the patient will need to see a qualified healthcare professional and get a prescription after her diagnosis. You will need an explanation for why the orthotics are necessary as well.
Keep in mind that the orthotics that you purchase online or at a local store will not be covered by your insurance and you will not be able to get coverage for the orthotics you choose just for recreational activities.
Depending on the type of insurance that you choose to go with, you may have restrictions on the materials that you can use in your orthotics and the methods used to create the orthotics. There are a lot of factors to consider when it comes to situations where the insurance will cover your custom orthotics.
It is usually best to talk to your insurance provider directly to see what they are willing to cover and if there are any unique situations that you should be aware of ahead of time. This can help prevent issues along the way and ensures that you do not get stuck with the big bill of a custom orthotic later on.
Insurance Coverage for Custom Orthotics
It may be surprising to hear that not all of the insurance plans out there will provide you with coverage for the custom orthotics that you need, even though they have to be done with the help of a podiatrist. Many people will need orthotics at some point to treat various foot conditions, so it is easy to assume that insurance would be willing to cover it.
And each health insurance plan can be a bit different in the amount of coverage it will provide. Some decide not to cover custom orthotics at all, no matter the situation. Some have specific conditions that need to be met before they will provide any sort of coverage for the patient if they need orthotics.
The amount that is covered can depend as well. Some insurance plans will not provide any coverage, some will only cover part of the amount that you need for custom orthotics, and some will cover the entire cost. Talking to your health insurance plan to figure out the exact amount of coverage that you can get is usually the best idea to help you know ahead of time.
Are There Insurance Companies Who Never Cover Orthotics?
Each insurance company is going to be a bit different in the amount of coverage that they are willing to offer to their customers. You will need to take a look at your policy to see what the specific rules are on whether you can get a pair of custom orthotics or not. Some of the insurance policies that will not cover custom orthotics include:
- Medicare and all Medicare supplement and advantage plans
- United Health Care Community Plan
- Molina for adults (though children 16 and under can get coverage)
- Regence UNIFORM (most of the other plans under Regence will cover the orthotics)
If you are confused about whether your insurance plan will provide you with the coverage you need on a pair of custom orthotics, then it is a good idea to give them a call and ask about this ahead of time. That will ensure there are no surprises later on when you go to work with your podiatrist.
What are Custom Foot Orthotics?
When we are talking about custom orthotics, we are looking at corrective footwear devices that are meant to fix many issues, such as alignment issues or pain and discomfort in different areas of the foot. The custom orthotic is going to be created out of a mold of your foot and can work to help you to improve posture and so much more.
Some of the tasks that you can expect out of a custom orthotic include:
- Holding the feet in the right position helps the muscles and ligaments function well
- Improve your gait
- Help with the healing process after surgery
- Reduce the amount of pain you have
- Help with posture
Many patients will choose to use these custom orthotics to help with a number of different foot issues like running injuries, shin splints, calluses, bunions, and heel spurs to name a few of the conditions. Your doctor will be able to take a look at your foot and determine what course of action to take.
How Do I Get My Custom Orthotics?
For the most part, you will have to work with the right medical professional to help you get the pair of custom orthotics that are right for your feet. A podiatrist will often provide you with the prescription that your insurance requires or you can get a referral from a doctor or a physiotherapist who may believe that you need one of these devices.
Acquiring a Set of Custom Orthotics
Many patients are worried about whether they will be able to afford the custom orthotics that they need to help with a number of foot conditions they may have. When you need a pair of custom orthotics to deal with a foot condition or with pain that will not go away, it is possible that you can utilize your health insurance to help cover some or all of the costs.
At Urthotics, our team will be able to work with you to determine the right treatment plan for your needs, giving you relief from a lot of the pain that you may feel on a regular basis. If you do need a pair of custom orthotics, we are happy to work with your insurance to make sure that you get the right coverage. Give us a call or leave your contact information so we can get back to you and start your journey to healthier feet!