Get Your Orthotics Covered By Insurance With These Easy Steps

Ever think you could injure yourself and your insurance company would be the one left limping? Believe it or not, a sprained ankle can leave you footing the bill for custom shoe inserts, which can mean the difference between walking pain-free and, well, wishing you were.

But is this a coverage gap or a sneaky tactic by insurance companies? We've prepared a 4-step process to outsmart the system and get your orthotics covered by insurance without breaking the bank.

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4 Steps to Get Orthotics Covered by Insurance

To get insurance coverage for your orthotics, you naturally need to have a health benefits plan.

The following steps are involved in this process:

1. Find the most suitable insurance provider while factoring in details about premiums and claims verification.
2. Research different plans and what they cover. You want to choose one that reimburses custom-made orthotics. Also, look for how many inserts per year it allows. If you're unsure, it's best that you confirm the specifics with the provider.
3. Get underwritten to determine your baselines and be eligible to receive coverage for some medical expenses. If your provider isn’t satisfied with them, they may send you a new quote with a higher premium to pay.
4. Choose your beneficiaries and begin paying your premiums based on your pre-specified agreement.

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Orthotics Insurance Coverage Requirements

The following are usually necessary to get your orthotics covered by insurance:

• A diagnosis from a podiatrist or foot care specialist
• A prescription for a custom orthotic from a qualified professional
• A description of the raw materials used to make the orthotics
• Details about the casting method
• A biomechanical gait analysis report
• A list of dates for the foot exam
• The orthotic order date
• A transaction receipt or payment evidence

Apart from the first two items that the medical practitioner provides, custom orthotic providers like Upstep will make the rest available on demand if you are looking for shoe inserts online. To make sure you find the best insole for you, take our 10-question quiz below.

Insurance Providers that Cover Custom-Made Orthotics

Many providers consider orthotics as therapeutic medical devices and will reimburse you under certain conditions. Here are some examples:

Aetna

Aetna plans may cover custom shoe inserts prescribed by a doctor to treat a documented medical condition. [1] This means they're deemed medically necessary, not for preventative reasons or general comfort.

Here are some limitations:

• Exclusions: Some Aetna plans might entirely exclude coverage, including shoe inserts.
• Pre-approval: You might need prior authorization from Aetna before getting insoles, especially if they are expensive.
• Copays and Deductibles: Even with coverage, you'll likely have to pay a copay or deductible.

Here's what you can do to get orthotics covered by Aetna:

• Review Your Plan Documents: They will detail your specific coverage for orthotics. You can find them online.
• Contact Aetna: You can also contact Aetna directly at 1-800-872-3862 to confirm your specific plan coverage for orthotic inserts.
• Doctor's Prescription: You'll typically need a doctor's prescription to get Aetna's coverage for orthotics.

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FSA and HRA

While these aren't precisely insurance providers, the flexible spending account (FSA) and Health reimbursement arrangements (HRA) provide full coverage when you pay for custom shoe inserts out of pocket.

You can use the FSA or HRA whenever you buy an insole as long as you have an active account. All you need to do is provide the purchase receipt on request. Plus, the type of orthotic and its price, quality, and material don't matter.

Medicare

On the other hand, Medicare pays for a percentage of the cost. It also comes with limitations, such as:

• It only applies to specific conditions, not all situations where orthotics might be helpful.
• There may be out-of-pocket costs.
• You'll pay 20% of the Medicare-approved amount for covered orthotics after meeting your Part B deductible.

The good news is that Medicare insurance covers a variety of orthotic options under Part B for seniors and young people alike. [2] This includes one pair of custom shoe inserts each year or one pair of extra-depth shoes.

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Walk Comfortably into the Future

While navigating insurance coverage can be complex, following these steps increases your chances of getting orthotics covered. Remember, consulting your doctor and insurance provider first is critical to a smooth experience.

With proper documentation and a clear understanding of your plan, you can take control of your foot health and walk comfortably into the future.

If you don't have insurance coverage for orthotics, prefer a more affordable option, or simply want a quicker solution, Upstep offers highly rated custom-made insoles. They are FSA-eligible and come with free shipping and a 180-day money-back guarantee.

All you need to do is order the impression kit, wait up to 4 business days, imprint your feet at home, and send it back free of charge with our pre-paid return shipping label.

» Get your custom-made orthotics with FSA/HSA insurance coverage