Insurance Information

You may have seen signs claiming
“3 pairs
of Orthotics for $500” or “Free Shoes with your Orthotics”
or even “Custom Orthotics the
Same Day”   

All of these claims violate the code of ethics of registered practitioners and thus would not qualify for reimbursement under your insurance.  This means that you are left paying the bill!

Here is where the problem starts.  In Ontario, manufacturing and fitting custom orthotics can be done by anyone.  This is NOT a regulated industry.  Simply put, that means anyone, regardless of their education and knowledge of foot and lower limb conditions, can make and sell orthotics.  Does this make any sense?

What you Don’t Know CAN Hurt You 

It is your responsibility to be educated about which prescribers and providers of custom foot orthotics, that your insurance company recommends and covers.  This will help ensure that your insurance claims are processed efficiently and you receive your money and are not stuck paying out of pocket.

Additional items that insurance companies may require to be submitted for a custom foot orthotic claim include:

  1. A copy of the biomechanical and gait analysis.
  2. A diagnosis of your condition indicating the medical necessity.
  3. A description of how the orthotics were made including the casting technique used to obtain the impressions of the feet and the raw materials used.
  4. PaidA copy of the orthotic order form from a recognized professional orthotic lab.
  5. A detailed receipt confirming “Paid in Full.”

Remember, insurance companies are very specific about foot orthotic coverage.  This helps to reduce fraudulent claims and ultimately keep costs down for you, the plan member.  It is your responsibility to check with your insurance to learn exactly what information you need to submit your claim.  If you do not understand some of the wording used in your insurance information, we can help you make sense of it.  We can also provide ALL the documentation you need to submit your claim.  You can also request a Letter of Predetermination of coverage.  A proper practitioner will not hesitate to provide this to you.

Claims that do not have the required information may be rejected until you provide the necessary documentation.

If your insurance company discovers that your benefits have been misused (either accidentally or intentional), they may not only decline your claim, but you’ll have problems with your future submissions.

Make sure you read the requirements of your insurance company carefully.