Once it is determined that you need to purchase foot orthoses (insoles or orthotics) the cost of the devices may be an issue for some. In Ontario, our government insurance (OHIP) does not provide coverage for foot orthoses and we often look to our group insurance or third party coverage. When investigating the coverage it is very important to find out all of the specifics of your individual policy. Policies between companies are often quite different from each other and often policies with the same insurance company are different between different employers. Before committing to purchasing the foot orthoses make sure that you check your policy to find out exactly what you have coverage for as well what needs to be submitted to the insurance company.
Important things to check:
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Do you need and have a prescription from a medical doctor? Most insurance companies require a prescription with a diagnosis and prescribed item (foot orthoses) from a medical doctor. This insures that the doctor has checked for possible underlying medical conditions and also provides a professional impartial third opinion of the requirement for the orthoses.
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Is the provider you have chosen accepted by the insurance company? Many insurance companies recommend preferred providers. In Ontario there is no regulations with respect to who can provide orthoses so the insurance companies have investigated to determine who is the best qualified to assess and provide the devices. For example, Certified Orthotists are preferred providers with many insurance providers.
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How is the assessment done? The person doing the assessment should ask about your medical history, perform a gait and biomechanical analysis and discuss your shoes, activities and expectations. Many insurance companies require copies of this information.
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How are the foot orthoses made? Custom made foot orthoses are usually made from a plaster impression (cast) of the feet held in a neutral position. The cast is then filled with liquid plaster which hardens to form a model of your feet. The materials used for the foot orthoses are then heated and molded under vacuum to form to the contour of your feet. The foot orthoses are then shaved or ground down to the proper angle. Some insurance companies require a plaster cast method for manufacturing.
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Can the provider bill the insurance company directly? Some insurance companies allow the provider to bill directly. If no direct billing is allowed, the client would pay for the foot orthoses first and submit a claim to be reimbursed.
When purchasing anything, the consumer is ultimately responsible for the cost of the item so it is important to understand exactly the costs involved prior to committing to anything. Once you understand all of the requirements of the insurance company and arrange the paperwork ahead of time, you can go confidently and comfortably into your new foot orthoses!
