Any ideas as to why most insurance companies don't cover orthotics?

[Belle0101]

The podiatrist I saw said I need custom orthotics for a problem I'm having. If I don't get them then I can look forward to increasing pain and deformity of two toes. Yeah me!

The orthotics alone will run $300 to $400 plus 2 or 3 office visits. Kick me while I'm down, the office staff said insurance companies almost never cover any of the related costs. Because of that, office policy dicatates that they be paid for in full before picking them up. OUCH! I asked them why they generally don't get covered and they said they didn't know why.

On the other hand, or foot as the case may be, I see a chiropractor for my back and he advised waiting to get them. For one, the podiatrist couldn't offer a guarantee that they would even help. And two, he has some ideas to try that insurance will cover. And three, since insurance isn't covering them there's no rush to get it done before our yearly deductible starts over in 2013.

 

[bgirldeb]

Have you called your insurance company to verify if you are covered or not? I would start there. It depends on what insurance you have, and if its through an employer it's up to them to decide if they want to pay for coverage for things that are not mandated.

 

[furb & dez]

Contact your insurance company and see what they say. Most likely if they are not covered, it's because although they could be considered durable medical equipment, the fact that they are custom fit makes them not qualify.

 

[daughtersrus]

The podiatrist I saw said I need custom orthotics for a problem I'm having. If I don't get them then I can look forward to increasing pain and deformity of two toes. Yeah me!

The orthotics alone will run $300 to $400 plus 2 or 3 office visits. Kick me while I'm down, the office staff said insurance companies almost never cover any of the related costs. Because of that, office policy dicatates that they be paid for in full before picking them up. OUCH! I asked them why they generally don't get covered and they said they didn't know why.

On the other hand, or foot as the case may be, I see a chiropractor for my back and he advised waiting to get them. For one, the podiatrist couldn't offer a guarantee that they would even help. And two, he has some ideas to try that insurance will cover. And three, since insurance isn't covering them there's no rush to get it done before our yearly deductible starts over in 2013.

I have a DD(18) with a very rare genetic disease. My DD has hearing loss. Our plan only covers a small % of hearing aids. They determine them to be a "patient convenience". Even after her ENT wrote a long letter explaining that she would need Speech Therapy every day to learn to hear, they refused to cover the aids but they said that they would pay for the SLP even if it was more expensive than the aids. I decided long ago that many times, insurance companies do not use logic.

The terms "medically necessary" and "durable medical equipment" probably apply in your case. See if you can find anything in your plan about these terms. If it's denied, you can try to appeal. If so, get as much documentation as you can from the physicians.

 

[Mel522]

A couple of years ago I pulled the muscle on the bottom of my foot. Not really sure how I managed that. Anyway I had to get custom orthotics because that was the only way to heal my foot. My insurance wouldn't cover that either. They told me I could just buy cheap inserts at the store and didn't need custom ones even though my doctor said I had to have custom ones to fix the problem.

 

[The Mystery Machine]

The podiatrist I saw said I need custom orthotics for a problem I'm having. If I don't get them then I can look forward to increasing pain and deformity of two toes. Yeah me!

The orthotics alone will run $300 to $400 plus 2 or 3 office visits. Kick me while I'm down, the office staff said insurance companies almost never cover any of the related costs. Because of that, office policy dicatates that they be paid for in full before picking them up. OUCH! I asked them why they generally don't get covered and they said they didn't know why.

On the other hand, or foot as the case may be, I see a chiropractor for my back and he advised waiting to get them. For one, the podiatrist couldn't offer a guarantee that they would even help. And two, he has some ideas to try that insurance will cover. And three, since insurance isn't covering them there's no rush to get it done before our yearly deductible starts over in 2013.

Depends on your condition and insurance.

My sister feels your pain, she was born with club foot and has surgeries, braces and orthotics.

Not sure what she gets covered however get the orthotic prescription from the podiatrist. Then shop around.

There are other places that make orthotics and some are better and some are worse. But bottom line I would check them all out and go from there.

Also not sure if I would trust a podiatrist to make that final determination with your feet. I would go get a second opinion from an orthopedic surgeon. Your feet are nothing to mess with as I am sure you know. Good Luck!

 

[mnrose]

I have a DD(18) with a very rare genetic disease. My DD has hearing loss. Our plan only covers a small % of hearing aids. They determine them to be a "patient convenience". Even after her ENT wrote a long letter explaining that she would need Speech Therapy every day to learn to hear, they refused to cover the aids but they said that they would pay for the SLP even if it was more expensive than the aids. I decided long ago that many times, insurance companies do not use logic.

The terms "medically necessary" and "durable medical equipment" probably apply in your case. See if you can find anything in your plan about these terms. If it's denied, you can try to appeal. If so, get as much documentation as you can from the physicians.

I feel your pain. My son needs a hearing aid as well (born with hearing loss in one ear) and insurance covers nothing. Very unfair. It's not as if the aid is "optional" for him! Thank goodness we are able to afford the aid (although those suckers are EXPENSIVE), but I really feel for parents who cannot and insurance covers nothing. Yet, insurance will cover drugs to allow people to have an erection. Don't get me started.....

 

[DizBelle]

I feel your pain. My son needs a hearing aid as well (born with hearing loss in one ear) and insurance covers nothing. Very unfair. It's not as if the aid is "optional" for him! Thank goodness we are able to afford the aid (although those suckers are EXPENSIVE), but I really feel for parents who cannot and insurance covers nothing. Yet, insurance will cover drugs to allow people to have an erection. Don't get me started.....

You need an erection to create more people to collect premiums on...

 

[PrincessSuzanne]

Contact your insurance company yourself and ask. I had a $1300 brace covered, my out of pocket was $100. I don't generally trust what they say at the office, unless I know for sure ahead of time.

I certainly wouldn't trust a chiropractor to tell me whether a podiatrist was right or not.

 

[tvguy]

Can't answer your question, but your insurance pays for a Chiropractor? I think I have had 5 difference health insurance companies over the last 30 years, and none ever covered Chiropractors.

 

[Christine]

I know many different people, with many different insurance coverages and, in my circle, orthotics seem to be covered. Some fully, some partially. I think you should call your insurance.

I have a condition in my left foot that is permanent. The custom orthotic really help. The condition will never heal; however, the orthotic keeps me from having foot pain and I can even run for exercise using them. In my case, they really increased my quality of life. The OTC inserts don't provide the support that I need in that one specfic place.

 

[Christine]

Not sure what she gets covered however get the orthotic prescription from the podiatrist. Then shop around.

There are other places that make orthotics and some are better and some are worse. But bottom line I would check them all out and go from there.

Also not sure if I would trust a podiatrist to make that final determination with your feet. I would go get a second opinion from an orthopedic surgeon. Your feet are nothing to mess with as I am sure you know. Good Luck!

How does this work with a prescription? When I have had orthotics done, my podiatrist makes molds/casts of my feet and then sends them off. I've never had a prescription written up.

Also, I started out at an orthopedic surgeon for my ankle/foot issue and they referred me out to a podiatrist. The ortho said that podiatrists are really much better qualified for foot issues; unless you happen to stumble upon an ortho who has a sub-speciality in feet. Or they keep a podiatrist on staff.

 

[PrincessSuzanne]

Depends on your condition and insurance.

My sister feels your pain, she was born with club foot and has surgeries, braces and orthotics.

Not sure what she gets covered however get the orthotic prescription from the podiatrist. Then shop around.

There are other places that make orthotics and some are better and some are worse. But bottom line I would check them all out and go from there.

Also not sure if I would trust a podiatrist to make that final determination with your feet. I would go get a second opinion from an orthopedic surgeon. Your feet are nothing to mess with as I am sure you know. Good Luck!

A Podiatrist specializes in foot care and surgery, why would you go to an Orthopedic surgeon that deals with just bones, not specifically bones of the foot?

 

[PrincessSuzanne]

How does this work with a prescription? When I have had orthotics done, my podiatrist makes molds/casts of my feet and then sends them off. I've never had a prescription written up.

Also, I started out at an orthopedic surgeon for my ankle/foot issue and they referred me out to a podiatrist. The ortho said that podiatrists are really much better qualified for foot issues; unless you happen to stumble upon an ortho who has a sub-speciality in feet. Or they keep a podiatrist on staff.

You can just ask the Podiatrist to write out a prescription or an order, just like they would for a medication, then take it to a place that specializes in Durable Medical Equipment. The DME place will know exactly what to do.

 

[7165red]

I am sorry to say I had 3 prs. of orthotic maded and they never helped my foot problem. I had to pay out of pocket and it was costly. I would check out over the counter ones the arn't much different from custom made ones. I wish you luck. I might each Dr. told me I need them and they would really help=not.

 

[The Mystery Machine]

How does this work with a prescription? When I have had orthotics done, my podiatrist makes molds/casts of my feet and then sends them off. I've never had a prescription written up.

Also, I started out at an orthopedic surgeon for my ankle/foot issue and they referred me out to a podiatrist. The ortho said that podiatrists are really much better qualified for foot issues; unless you happen to stumble upon an ortho who has a sub-speciality in feet. Or they keep a podiatrist on staff.

As a PP said, you can get that prescription and take it somewhere else and have the stuff made.

A Podiatrist specializes in foot care and surgery, why would you go to an Orthopedic surgeon that deals with just bones, not specifically bones of the foot?

I would want the opinion of an orthopedic surgeon who deals with my frame as well. Not saying I am discounting a podiatrist at all, but I would get another opinion.

OP says this is something that will impact her quality of life forever.

This is something in which another opinion would be good to get. You never know.

 

[Anne34]

Blue Cross covers my daughter's orthotics. We can get 1 pair per year covered. She is still growing so that really helps. She sees an orthopedic doctor who specializes in feet.

 

[PrincessSuzanne]

As a PP said, you can get that prescription and take it somewhere else and have the stuff made.

I would want the opinion of an orthopedic surgeon who deals with my frame as well. Not saying I am discounting a podiatrist at all, but I would get another opinion.

OP says this is something that will impact her quality of life forever.

This is something in which another opinion would be good to get. You never know.

I might get a second opinion, but it would be another Podiatrist, not an Ortho.

 

[denisenh]

I don't think that custom orthotics are too much better than otc ones. What about http://www.footmapping.com/footmapping/home/index.jspa maybe that will do?

 

[ADisneyQueen]

I have custom orthotics and my insurance paid for them( blue cross/blue shield). My prescription did come from an orthopedic surgeon, maybe that makes a difference. I have mine b/c of a prior foot surgery after I fell. I love my inserts and would pay oop for mine just to help my foot pain.