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Orthotics & Orthopaedic Footwear Insurance

Benefits, Health

What is Orthotics?

Orthotic medicine is the focus, design, manufacturing and application of orthopaedic footwear and orthotics.

Orthotics are corrective devices worn inside a shoe to support and align foot function. Custom-made orthopaedic footwear is typically used to treat a congenial deformity, traumatic injury or a disease that affects the feet.

Different types of Orthotics

There are 2 types of orthotics. Rigid orthotics and soft orthotics. Rigid orthotics or also known as “functional orthotics,” are made from materials such as plastic or carbon fiber. These types of insoles are designed for walking shoes or dress shoes with closed toes and low heels. if your foot doesn’t work like it should, functional orthotics ease foot aches and strains as well as pain in the legs, thighs, and lower back.

On the other hand Soft orthotics, also known as “accommodative orthotics,” are made from soft compression materials. These orthotics provide cushioning to take the pressure off uncomfortable or sore spots from conditions such as plantar fasciitis or diabetic foot ulcers. Due to their size, you may require prescription footwear in addition.

If you are on the move and live an active lifestyle you can also get special orthotics designed for sporting equipment.

Are Orthotics / Orthopaedic footwear covered by insurance?

To qualify for coverage under your plan, they must be custom made of raw materials. In addition, they must be crafted using a three dimensional (3D) cast of the insured person’s foot. If permanent custom modifications are made to shoes manufactured and branded as orthopaedic, they are also eligible for coverage. However mass-produced, off the shelf footwear, such as sandals, comfort footwear or walking shoes are not eligible for coverage under your plan.

Non Eligible Orthotic/Orthopaedic Claim

  • Commercially made, over the counter products, even when they have a label that says “orthotic”
  • Insoles that you purchase for comfort rather than a medical necessity
  • Inserts that you use specifically for sports or other physical activities
  • Expenses that you in-cure cleaning orthotics

Eligible Orthotic/Orthopaedic Claim

  • Detailed prescription from an eligible provider (see list below), including the medical diagnosis of the condition
  • gait analysis/bio-mechanical evaluation
  • detailed lab invoice that confirms the orthotics or orthopaedic footwear are custom made
  • description of the cast method/make and model of the orthopaedic shoe
  • detailed receipt that has been paid-in-full, including a breakdown of charges, date received and providers name and address

Eligible Providers for Orthotics / Orthopaedic footwear

Physician
Prescribe
Preform gait analysis or biomechanical evaluation
Dispense
Orthotist
Prescribe
Preform gait analysis or biomechanical evaluation
Dispense
Pedorthist
Prescribe
Preform gait analysis or biomechanical evaluation
Dispense
podiatrist
Prescribe
Preform gait analysis or biomechanical evaluation
Dispense
Chiropodist
Prescribe
Preform gait analysis or biomechanical evaluation
Dispense
Orthopedic Surgeon
Prescribe
Preform gait analysis or biomechanical evaluation
Dispense

Do you have any questions about orthotics or orthopaedic footwear? Find out more by referring to the PDF directly here… or contact us today and one of our advisors can help you find a plan that encorperates orthopedic care.

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