When you have foot pain, it can be a relief knowing you have insurance coverage to help with the cost of keeping your feet happy and healthy. However, insurance plans can be confusing and difficult to navigate, especially if it’s all new to you! We’ve got you covered, with answers to some of your most frequently asked insurance coverage questions.
What is third party insurance?
Third party insurance or extended health care benefits are typically either provided to you by an employer or purchased yourself through an insurance company, to cover costs that your provincial healthcare plan does not cover. Orthotics, orthopedic shoes, orthopedic bracing for knees, ankles and toes, chiropody services and compression stockings are typically not covered through provincial healthcare. Most insurance companies offer coverage for these items, but different plans offer different levels of coverage.
What does my insurance plan cover?
No matter what insurance company you’re with, each plan can vary when it comes to the exact terms of coverage. It’s best to reach out to your provider with your plan number found on your member card to find out what coverage you have. These plans have either been negotiated by your employer or were chosen by you when you purchased it privately. It is helpful to have a quote for the items you are inquiring about. A quote or “estimate” or “predetermination” gives you details about the product, model number, specifications, service and price associated with it. This provides your insurance company with all the details they need to determine coverage before you choose to purchase/proceed with the product or service. It is always recommended to submit a quote or, at the very least, talk to your insurance provider before choosing to move forward with any orthopedic product so that you can make a financially informed decision.
What is the difference between medical or custom items and non-medical or over-the-counter items? Orthotics, shoes, braces, and compression come in all kinds of categories, both medical/custom and non-medical/over-the-counter. When requesting a quote, it is important to note which category they fall into as insurance plans vary on coverage, and these details make a difference. Most providers will not cover anything that can be purchased over-the-counter as they cannot ensure that a credentialed provider dispensed the item for a legitimate need. Medical and custom items must be dispensed by a registered/certified and approved provider with supporting documentation.
Do I need a prescription?
In most cases you will require a prescription from a physician or nurse practitioner (or in some cases, a chiropodist) to qualify for insurance coverage from your provider. The prescription indicates that the items you are asking for are medically necessary for your health and can help when the adjuster or adjudicator of your claim is processing it for reimbursement. You can ask about the prescription requirements when you submit a quote or by calling your provider with your plan number. However, to simply come for an assessment with a BioPed clinician, a prescription is not required. We can always advise and help you request one from your physician if it is necessary for insurance and policy standards.
What can we direct bill for?
We work closely with many insurance providers. BioPed is proud to be a preferred provider with several insurance companies and may have direct billing privileges for some items discussed here. It is always best to ask your local BioPed if they can direct bill for any items. These policies are set in place by the insurance industry. However, if we are unable to directly bill your items to your insurance provider, we will help you navigate the predetermination process to determine coverage, which can help you get your claims paid out faster.
When it comes to your feet, we want you to have all the answers to relieving your foot and lower limb pain. Insurance can be tricky, but your trusted BioPed team is here to help!
