Need an Orthotic? Make Sure Yours Are Covered By Medical Insurance.

Let’s say your family doctor or podiatrist prescribes you an orthotic for your foot problem. You go to your chiropractor, orthotic store, or physiotherapist to get one made, spend a few hundred dollars, and submit the expense to your Extended Medical Insurance Plan. Imagine your surprise when you get a letter back from the insurer saying that your orthotic is not covered and that they won’t be reimbursing you. What gives? Extended medical insurance providers, like ClaimSecure, Blue Cross an others are getting stricter about their coverage for orthotics. For example, ClaimSecure is now insisting that the following requirements must be met:

In order for your claim to be considered eligible, your claim must meet the following three
conditions:

1. Referral by an Approved Service Provider
2. Orthotics or Custom made shoes must be manufactured or modified in an off-site facility.
3. Dispenser must have one of the approved credentials.

A referral can only be written by one of the following Approved Service Providers:
• Physician (MD)
• Podiatrist (DPM)
• Chiropodist (D CH or D Pod M)

In order to be covered, the orthotic can only be dispensed (or made) by one of the following:

• Orthotist CO or CPO(c)
• Pedorthist C Ped (c) or C Ped (MC)
• Podiatrist (DPM)
• Chiropodist (D CH or D Pd M)
• Orthésistes du Pieds (member of CCCOP)

Finally, a paid in full invoice is required. Please note that while these requirements are industry standard your plan may differ slightly. If unsure, contact your Benefits Provider for confirmation of your specific plan details. Don’t get stuck with orthotics that you can’t get reimbursed for!

You can see all of ClaimSecure’s orthotic coverage requirements on page 8 of this guide.

Published on:March 6, 2015
Posted in Uncategorized by dm