How to get orthotics covered by insurance

Now for this article I am going to attempt to make it ideal for both a doctor (probably a Podiatrist) or for a patient who wants to know if they can get the orthotics covered. Custom Orthotics are expensive, ranging anywhere from $300-600. In some cases they are more expensive than some minor surgeries, so getting insurance companies to cover them would probably be a good thing. It reduces cost to the patient and allows the doctor to collect a decent profit. For the vast majority of cases orthotics can improve a condition from Plantar Fasciitis, Achilles Tendonitis, Flat feet or just chronic foot pain.

Now the first answer to getting orthotics covered is for the physician to document, document, document. The more treatments you can document the greater chance of getting the insurance to cover orthotics for the condition. For example, if the patient has Plantar Fasciitis, if the physician has documentation of cortisone shots, stretching routings, physical therapy, night splints, etc., that will greatly increase your chances of getting them covered. In other words, if you show up on your first visit and expect custom orthotics to be covered you are nuts. Listen, there are doctors that will try and they will fail to get them covered and the patient will be stuck with the bill. That is actually okay though. Custom Orthotics can be an effective treatment. If the patient does not mind spending the money then by all means spend the money.

One treatment that I think can help a great deal in getting custom orthotics covered is if the patient has tried a course of physical therapy. This does a couple things for the insurance company. It indicates that the patient is compliant and multiple modalities have been attempted to correct the condition, such as flat feet or Plantar Fasciitis.

One item that a lot of doctors overlook when documenting for orthotics is does the patient have any systemic conditions such as Diabetes, Renal disease, any kind of Musculoskeletal condition. These can help and contribute a great deal to an insurance company covering the cost of the orthotics.

But at the end of the day this is all well and good. It all comes back to central tenant: document, document, document. The physician needs to document everything and anything that has been done. The more documentation the more likely the orthotics get paid.

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