Foot Care Orthotics and Insurance

28 Jun Foot Care Orthotics and Insurance

Orthotics and Insurance

If you need custom orthotics or professional foot care, will your health insurance plan cover the costs?

The simple answer is, it depends. Read on for a summary of what you can expect when looking for coverage for custom orthotics and other podiatric prescriptions.

Foot Care and Insurance

Most major health insurance plans cover a wide range of foot problems and will pay for treatment of ingrown nail, plantar fasciitis, Achilles tendonitis and other conditions. They also include podiatrists as qualified health professionals, although if your health plan is a health maintenance organization (HMO) you’ll need a referral to a podiatrist.

But when it comes to orthotics, there is no hard and fast rule. For instance, Blue Cross offers reimbursement for custom orthotics but Aetna, Kaiser Permanente and Cigna do not. Medicare covers soft orthotics for diabetics but not custom orthotics.

Are You Covered?

The only way to know for sure what your plan covers is to check your policy. You can find this by reading the plan’s details, going to the insurer’s web site, or calling their customer service number. Most health insurance companies have 24-7 call centers staffed by representatives who can easily find that information and answer your questions quickly.

Shuman Podiatry & Sports Medicine works with most major health insurers in Virginia and the D.C. metropolitan area.

Filing a Foot Care Insurance Claim

Even if your insurer provides orthotics coverage, you’ll need to provide specific documentation. For instance, a claim for orthotics coverage to Blue Cross must include:

  • the podiatrist’s prescription and a medical diagnosis;
  • proof that the orthotics were made from raw materials;
  • proof that the prescriber used 3D casting of your foot;
  • a bio-mechanical assessment.

Shuman Podiatry’s custom orthotics are always made for your feet using 3D technology and a thorough gait and bio-mechanical assessment. You can count on Dr. Shuman to provide full documentation in line with your insurer’s requests.

For specific information about what’s required on your plan, check your insurer’s coverage requirements and follow their instructions carefully.

Other Foot Conditions

What about the more common foot problems? Again, it depends.

  • Fungal Nail – Most insurance companies won’t cover the costs to treat fungal nail because they consider it a cosmetic issue. Your best bet is to use your Health Savings Account (HSA) or Flexible Spending Account (FSA) to pay for this treatment.
  • Ingrown Nail – Most insurance companies do cover treatment for ingrown nails. In most cases they will even pay for surgery if it’s necessary. You may have to pay a small co-pay amount.
  • Hammertoe – Your insurance company should cover this treatment, but may require you to try non-surgical options first. Dr. Shuman can provide you with a range of treatment options that may make surgery unnecessary.
  • Morton’s Neuroma – In most cases, treatment for this is covered by insurance. Consult Dr. Shuman for the best treatment plan.


Check Your Coverage

The first step is calling your insurance company to determine just what they cover when it comes to custom orthotics. You’ll also need to know what documentation they need and make sure you get it.

Some insurers have a “use it or lose it” provision for orthotics, so the sooner you find out, the better.

And what’s step two? Call Shuman Podiatry and schedule an appointment to fix your foot problems. We’ll work with you to put together a treatment plan, discuss your payment and insurance options, and get you back on your feet.

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