If you have ever considered getting custom orthotics to help with foot, knee, or back discomfort, you might have one important question: Does third-party insurance cover products like this? In short, yes, but it is plan dependent and there could be limitations or requirements from the insurance company. Understanding third-party insurance can be confusing. This blog will break it down so that you can make an informed decision and keep Doing More!
What Is Third-Party Insurance and How Does It Work?
In Canada, third-party insurance coverage typically refers to extended health benefits that are offered by your employer or purchased privately. It is provided by an organization other than the government, and covers items and services which are typically not covered by the government insurance. Third-party insurance varies widely from plan to plan and from company to company but may include custom orthotics or paramedical practitioner coverage.
Does Third-Party Insurance Cover Orthotics?
In many cases, custom orthotics are covered by most third-party plans, but they typically require certain criteria to be met. These criteria can include any or all of the following:
- Medical Prescription: A prescription from a medical doctor or other recognized professional (Chiropodist, Nurse Practitioner) that names your condition (the reason you require the orthotics).
- Proper Documentation: This would include the gait analysis and biomechanical assessment, as well as the breakdown of orthotic manufacturing process (materials used and how the cast of the feet were taken).
- Detailed Invoice: The date of dispense, breakdown of the cost of the orthotics and the location of the manufacturing of the orthotics.
- Proof of a Qualified Professional: The BioPed Pedorthist or Chiropodist’s certification number must be present on the paperwork.
Tips for Clients Navigating Insurance Coverage
Before your appointment, you should do some homework to create a smoother process.
Call your insurance provider before your appointment: Ask if you have custom orthotics coverage and whether you require a medical prescription with diagnosis. You’ll also want to know what type of healthcare professional can assess and dispense the orthotics per your plan. Finally, you’ll want to learn what amount your coverage is for. Some plans have a maximum limit and a frequency date. Even where coverage is present, you’ll likely have some out-of-pocket expenses. Most plans do not cover 100%.
Once you receive your new custom orthotics, keep all receipts and documentation. Most plans require detailed proof, and BioPed clients receive a full package to help streamline the claim.
We work closely with many insurance plan providers and will help you navigate the claim submission process and provide a quote where it is necessary to predetermine coverage. We issue all required paperwork for insurance claim submission to ensure a smooth, simplified process. Insurance reimbursement direct to the plan member who submits – you! – is typically expedited.
