What you need to know about Orthotic Insurance Coverage
Many extended health benefit plans cover the cost of custom orthotics in part or in whole. Each benefit plan is unique and may change from time to time. Therefore, we strongly encourage you to check the specific details of your health benefit plan to ensure you understand your coverage and any limitations. For example, one plan may cover custom orthotics at $500 per calendar year and another plan for employees in the same company may only cover 80% of costs up to $300 every 2 years.
Orthotic coverage can be complex, but our staff would be glad to help you understand your coverage. At your request, our reception staff can call your benefit plan's administrator with you in order to verify the details and requirments for you to obtain coverage. In addition, we are able to submit claims for pre-determination, if necessary, in order to obtain confirmation that your claim will be covered.
In this page, we will outline some of the most common requirements of health benefit plans for custom orthotic claims submissions in Ontario, Canada. We trust this information will be helpful to you as you check the specific details of your plan for custom orthotics.
Most health benefit plans require the following information for orthotics claims:
- a prescription for custom orthotics from a medical doctor, surgeon or podiatrist
- a description of the raw materials used to make the orthotics
- a description of the casting method - eg. 3D volumetric cast
- a biomechanical gait analysis report
- a list of the exam date, order date and dispensing date
- a detailed lab invoice or "Proof of Manufacturing."
- a statement of account paid in full with or without a transaction receipt
The Prescriber
Most health benefit plans for custom orthotics require a prescription from a list of designated health professionals. Most commonly, the list of prescribers includes a medical doctor, surgeon or podiatrist. In some plans, Chiropractors are able to prescribe the orthotics. If your plan allows for a Chiropractor to prescribe the custom orthotics, then Dr. Nyman will be able to provide you with all the documentation required.
If your plan requires a prescription from a medical doctor, surgeon or podiatrist, then you should obtain this prescription prior to ordering your custom orthotics. The prescription from your medical doctor, surgeon or podiatrist should include the following: 1) a diagnosis of your condition that requires orthotics (e.g. plantar fasciitis); 2) a prescription for custom orthotics. Please note that "foot pain," "flat feet" or "heel pain" are symptoms or signs, but not a diagnosis accepted by most insurers.
The Dispenser
Your health benefit plan may also have a list of health professionals who are able to dispense the custom orthotics. You should check to see which type of providers may dispense custom orthotics under your plan's guidelines.
Dr. Nyman is a Chiropractor and most plans accept custom orthotics dispensed by a Chiropractors. Chiropractors are well trained to dispense custom orthotics. Your orthotic consultation will consist of a history taking, physical examination, posture examination, biomechanical gait examination and a 3D volemetric casting of your feet.
At present, we are aware of only 1 plan in Canada that does not include Chiropractors as a dispenser for custom orthotics. The designation of "Chiropodist" should also not be confused with a "Chiropractor." Please check the details of your plan carefully to ensure your plan allows a Chiropractor to dispesne the orthotics prior to placing your order.
Would you like to know more about our custom orthotic therapy insurance coverage?
If you would like to know more about our custom orthotic therapy or if you have further questions about your insurance coverage, then please contact us and our friendly staff will be glad to assist you.