custom-made orthotics for kids

[fac]

I wonder what is people's experience with podiatrist and having to custom-make orthotics for your kid, and how does the insurance work

Recently, I found out DD has an extra bone near her ankle, according to the 2 podiatrists we had seen, it happens to a small percentage of the population. Her podiatrist recommened customized orthotics, but then told me that because the lab in not in-network, hence I would have to pay over $450, but then when my insurnace told me that the podiatrist is in-network, hence I shouldn't be paying, but then they couldn't answer when I brought up the lab being out of network.
I checked with a second in-network podiatrist, the office told me that as long as the podiatrist is in-network, the lab is irrelevant, even if we were to pay for the orthotics, it is around $300.

When we met the 2nd podiatrist, he asked us to go back to see him a second time. Because of my bad experience with some SLPs and ENT doctor (another thread), and because the 1st podiatrist made a decision early on what needed to be done. I am not sure whether the 2nd podiatrist just want us to go back again and again..

Note that my younger DD has a minor problem with the feet, the 1st podiatrist recommended over-the-counter insert, it worked for a few months, but as she complained her feet hurt again, hence I brought her to see the podiatrist as well and am prepared to make customized orthotics for both kids.

just some questions.. I hope someone can help to answer.
a. if your kids have to use a customized orthotics, how many visits did the podiatrist need to make the decision?

b. What do we have to look out for in the cutomized orthotics? should I be concerned on the materials to make the orthotics? I was suprised that the 2nd podiatrist can charge us much less than the first..

c. What is your experience of having the kids to use the orthotics? saying taking care of the orthotics? buy an extra one? This is new to me and I don't even know what question to ask..

d. I understand each insurnace is different, but what is your experience with in-network podiatrist and out-of-network lab..

The 1st podiatrist was recommended by the pediatrician, hence I have confidence in him, but then if we use him, we will be paying nearly $1000 oop for the deductible.
thanks

edit to add, found this thread
http://www.disboards.com/showthread.php?t=1541224

 

[DVCJones]

I wonder what is people's experience with podiatrist and having to custom-make orthotics for your kid, and how does the insurance work

Recently, I found out DD has an extra bone near her ankle, according to the 2 podiatrists we had seen, it happens to a small percentage of the population. Her podiatrist recommened customized orthotics, but then told me that because the lab in not in-network, hence I would have to pay over $450, but then when my insurnace told me that the podiatrist is in-network, hence I shouldn't be paying, but then they couldn't answer when I brought up the lab being out of network.
I checked with a second in-network podiatrist, the office told me that as long as the podiatrist is in-network, the lab is irrelevant, even if we were to pay for the orthotics, it is around $300.

When we met the 2nd podiatrist, he asked us to go back to see him a second time. Because of my bad experience with some SLPs and ENT doctor (another thread), and because the 1st podiatrist made a decision early on what needed to be done. I am not sure whether the 2nd podiatrist just want us to go back again and again..

Note that my younger DD has a minor problem with the feet, the 1st podiatrist recommended over-the-counter insert, it worked for a few months, but as she complained her feet hurt again, hence I brought her to see the podiatrist as well and am prepared to make customized orthotics for both kids.

just some questions.. I hope someone can help to answer.
a. if your kids have to use a customized orthotics, how many visits did the podiatrist need to make the decision? The first visit. My DD had flat feet and needed inserts for her shoes. Her physical therapist referred us to him because she noticed DD flat feet.

b. What do we have to look out for in the cutomized orthotics? should I be concerned on the materials to make the orthotics? I was suprised that the 2nd podiatrist can charge us much less than the first.. I never gave it much thought. I just had them made for her. I guess it depends on what you are having made. There are so many types of orthodics.

c. What is your experience of having the kids to use the orthotics? saying taking care of the orthotics? buy an extra one? This is new to me and I don't even know what question to ask..My DD never had a problem. She was very young and we just kept them in her shoes. We never lost them.

d. I understand each insurnace is different, but what is your experience with in-network podiatrist and out-of-network lab..Our insurance paid for half.

The 1st podiatrist was recommended by the pediatrician, hence I have confidence in him, but then if we use him, we will be paying nearly $1000 oop for the deductible. OUCH!!! Perhaps you should use the one your insurance would cover. It is orthodics not surgery.
thanks

edit to add, found this thread
http://www.disboards.com/showthread.php?t=1541224

Good luck.

 

[Sadie22]

My son overpronates which we found out when he was in high school and got stress fractures from jogging to build endurance for a backpacking trip. He was having increasing pain. The stress fractures were diagnosed by special x-rays following injection of a medium that showed on the studies.

There was a sports medicine specialist with our family physician at that time who prescribed a leg brace on the affected side and suggested Junior try Spenco insoles as well as switching to wearing New Balance shoes with motion control fitted at the store he recommended to people with foot problems. The stress fractures healed in time but then recurred when Junior tried to resume jogging, so the doctor sent him to a podiatrist to investigate custom-made orthotics.

The podiatrist made plaster casts or molds of Junior's feet in the office and then the completed orthotics were made by a lab. Both were in network and fully paid for by our insurance other than the copays for a visit to a specialist. Our insurance is an all-inclusive plan through a huge nationwide company with many subscribers. Others may be different; it's best to call and ask questions.

In this doctor's favor, he would charge one copay for two visits, something I have never had any other specialist do.

I did have a problem when getting the second pair two years after the first. I had called the insurance company myself before the appointment was made and verified that a second set could be obtained at this time and would be fully covered. I'm not sure whether it was one pair per year or one pair every two years. I'm sure that if Junior's condition changed he would be able to get new orthotics then.

The second time around the podiatrist at first did not understand that my college-age son was still covered by Dad's insurance plan as a fulltime student to Age 25, so he told my son the orthotics were expensive and convinced him to leave without being fitted. This was one time I didn't go along to the appointment as my father was in the hospital. I sent my son back after several phone calls to the doctor's billing department when the billing person insisted the orthotics were not covered, and even conversations with the doctor who said he paid a lot of money to the billing person and that she knew what she was talking about. I called the insurance again and again got verification of coverage. At the podiatrist's insistence I ended up paying $250 in advance (what he said the lab woudl charge him) so my son could get the second pair of orthotics. All this took place in the weeks before my father died, causing anxiety I didn't need at that time, and took so long that the orthotics did not come in before my son left for college. I insisted that the charges be submitted to insurance, and of course there was full coverage. Then it took extra time to get the $250 refunded, and they refunded via check to my son rather than crediting my credit card, so there was an extra trip to the bank to deposit the check.

Junior has been wearing his orthotics and four years later has not had significant further problems so he has not returned to a podiatrist. He does however ride a stationary bike for lower impact exercise, and now sticks to the jogging track at the nearby high school rather than jogging on streets, and he walks more than he runs.

 

[Anne34]

My DD 12 has custom orthodics. She had a lot of pain in her left foot, especially after soccer. They orthopadic put her in a boot and it helped a bit, but when it didn't heal althogether he suggested the podiatrist in the practice. We saw the podiatrist once and he immediately saw that she has very flat feet and overpronated, thus causing the pain on the outside of her foot. They made plaster casts that day and sent them out. She wore them in her gym shoes and then transferred them over to her soccer shoes when she played (on a travel team). Fast forward a year -- her foot was hurting again. We took her back to the podiatrist and she had grown a lot and the insert did not fit her anymore. This time they had a new machine that takes a picture of the foot (she laid her foot on it and it) and they made the insert from that. We have been lucky -- Blue cross pays for 1 set of inserts per year -- we only pay our $30 deductible.

The podiatrist did say that we can use over the counter inserts, but she would be buying a new set every 6-8 weeks since she is so hard on them with her sports, daily gym class, etc.. The over the counter ones are around $80-100. For us it's not worth it since insurance does day for them, but we did buy an extra pair over the counter to use as a backup.

Good luck with your decision.

 

[indimom]

I also have an extra bone in both of my feet. An x-ray was all I needed for diagnosis. The podiatrist recommended custom made inserts (with the possibility for surgery if the bones continued to cause problems). I had inserts made throughout my growing years, into high school. They worked perfectly and I had no more pain issues.
My last pair held up for over 10 years. I wore them as needed (mostly during my pregnancies and when doing a LOT of walking). I finally got rid of them about five years ago, just because I didn't think I needed them.
I wouldn't worry about how "long-lasting" the materials will be right now, since they will have to be resized long before they would wear out...
I never lost or broke an insert. I generally kept them in my favorite tennis shoes, and put them in other shoes as needed, and they needed no care or upkeep.
(My information is somewhat dated, obvioulsy, but it sounded like your daughter is going to be getting a similar (although more up to date) treatment for the same condition, so I thought I'd share.

 

[fac]

thank you all for sharing. Saddie22, sorry for your lost.

I never aware of overpronated feet, but after reading the board, and when I went to DD's ballet observation class, I noticed a number of kids have overpronated feet. My DD9 sometimes cried at night because her legs hurt when she was younger, we talked to the pediatrician and she was never able to explain the problem. I found out when I tried to fit her ballet slippers and noticed her feet looked wider. The pediatirican initially did not recommend to see the podiatrist as she thought her feet can be corrected by inserts, hence no reason to spend $400.

I was suprised the 2nd podiatrist did not just make the orthotics, he got the office to wrap DD's feet using some kind of bandages and asked DDs to give him feedback before he decides on the material in the next visit. But his office is part of a medical group, hence I am not sure whether it is a reason they get the clients going back again and again ( I mentioned ENT in an ealier post, the ENT saw DD several times and each time sent DD to a different S/L pathologist, then I noticed my insurance company paid him around $600 per visit. What a great way to make money)

I am going to see whether he is going to make the orthotics next time, if not, I will just go back to the first podiatrist.

 

[hugabearjo]

If you have a shriner's hospital in your area they specialize in orthopedics. My son has other issues and will be referred away and I am very sad. Shriner's has been a God send for our family. They also don't as of today but will soon bill insurance and will then write off what ever insurance doesn't pay. It is a no out of pocket expense to family service they do. The doctors we have seen have been top of the line. I am so pleased. Call your local chapter and see what they can do for you

Good luck. Having a child need adaptation isn't fun or easy. Hang in there.

 

[Sadie22]

Fac, thank you, it was over five years ago.

So Junior has been using his two pairs of orthotics for about five and seven years and they haven't broken. For care he rinses them off occasionally as far as I know. Now that he buys his own shoes I am having trouble convincing him to only buy the well-constructed but more expensive ones.

We are able to search for in-network providers online. Do you have that capability, or do you have a catalog listing providers? Perhaps you could go to the podiatrist armed with a list of in-network labs. There may be a reason why he uses a particular lab rather than another, or he may just not be aware of another lab which would be in-network.

 

[3boymthr]

Good luck!

You are so lucky your insurance covers them.

Our insurance did not - $500 OOP cost because they did not extend past DS' ankle. Ouch!

The good thing was they lasted about 4 years - even tho he was only a 3 when they were made. And because they did last so long we haven't gone back as we were told he only had to wear them until he was seven.

 

[tiredsigh]

DS has pigeon toeing. I did not go to a podiatrist. I went to two different pediatric orthopedic surgeons to get their input. His was so bad that he fell all the time and would often have black eyes.

We wore a night brace for a year. It was covered by my insurance. Insurance is different.

Have you taken him to an orthopedic specialist? You can definitely find one covered by insurance. Just find one who handles a lot of pediatric patients.