How To Get Orthotics Covered By Insurance?

Orthotics can be a lifesaver for people who suffer from foot pain, knee pain, or other mobility issues. However, the cost of orthotics can be quite expensive, making it difficult for many people to afford them. Thankfully, many insurance plans…

Orthotics can be a lifesaver for people who suffer from foot pain, knee pain, or other mobility issues. However, the cost of orthotics can be quite expensive, making it difficult for many people to afford them. Thankfully, many insurance plans cover orthotics, but the process of getting approval can be daunting. In this article, we will discuss how to get orthotics covered by insurance, so you can get the relief you need without breaking the bank.

How to Get Orthotics Covered by Insurance?

How to Get Orthotics Covered by Insurance?

Orthotics are specialized devices used to support or correct various foot, ankle, and leg conditions. They are often prescribed by podiatrists or orthopedic specialists to improve overall foot health and reduce pain. However, the cost of orthotics can be a significant financial burden for many patients. Luckily, insurance coverage can help offset the cost of orthotics. Here is what you need to know to get your orthotics covered by insurance.

1. Check Your Insurance Policy

The first step in getting your orthotics covered by insurance is to check your insurance policy. Look for coverage details related to durable medical equipment (DME) or orthotic devices. If you are unsure about your policy, contact your insurance provider and ask if orthotics are covered and what the requirements are for coverage.

It is important to note that insurance policies vary widely in terms of coverage and requirements. Some policies may cover only a portion of the cost, while others may require pre-authorization or a doctor’s referral. Understanding your policy will help you navigate the insurance process more easily.

2. Get a Prescription

To get your orthotics covered by insurance, you will need a prescription from a qualified medical professional. This can be a podiatrist, orthopedic specialist, or other healthcare provider. The prescription should include the specific type of orthotic device needed, the reason for the device, and any other relevant information.

It is important to follow the prescription exactly when ordering your orthotics. Any deviations from the prescription could result in your insurance claim being denied.

3. Choose a Provider

Your insurance policy may have a list of approved providers for orthotics. If so, choose a provider from the list to ensure that your claim will be covered. If there are no approved providers listed, you can choose any provider, but be sure to check their credentials and reputation before ordering your orthotics.

It is also important to note that some insurance policies require that the provider be accredited by a specific organization. Check your policy to see if this requirement applies to you.

4. Submit a Claim

Once you have your prescription and have chosen a provider, you can submit a claim to your insurance provider. Your provider should be able to assist you with the claim process and provide any necessary documentation.

Be sure to include all required information and documentation with your claim to avoid delays or denials. This may include the prescription, provider information, and any other relevant information requested by your insurance provider.

5. Follow Up

After submitting your claim, follow up with your insurance provider to ensure that it is being processed. If there are any issues or delays, address them immediately to avoid further complications.

6. Be Prepared to Pay Out-of-Pocket

While insurance coverage can help offset the cost of orthotics, it may not cover the entire cost. Be prepared to pay out-of-pocket for any portion of the cost that is not covered by insurance.

If you are unable to afford the out-of-pocket cost, there may be other options available to help offset the cost. Talk to your provider or insurance company about any financial assistance programs that may be available.

7. Understand Your Options

There are many different types of orthotics available, ranging from off-the-shelf to custom-made devices. Be sure to discuss your options with your healthcare provider to determine which type of orthotic is best for your specific needs.

It is also important to know that insurance coverage may vary depending on the type of orthotic device. Be sure to check your policy for coverage details related to specific types of orthotics.

8. Keep Records

Keep detailed records of all interactions with your insurance provider and healthcare provider related to your orthotics. This can include receipts, invoices, and any other relevant documentation.

Having detailed records can help you track the status of your claim and ensure that you are not being overcharged for your orthotics.

9. Advocate for Yourself

If your insurance claim is denied or you are having difficulty navigating the insurance process, advocate for yourself. Contact your insurance provider and ask for an explanation of the denial or for assistance with the claims process.

You can also reach out to patient advocacy groups or legal aid organizations for assistance.

10. Benefits of Orthotics

Orthotics can provide numerous benefits for those with foot, ankle, and leg conditions. They can improve overall foot health, reduce pain, and prevent further damage to the feet and legs.

Compared to surgery or other invasive treatments, orthotics are often less expensive and have fewer risks and side effects. They can also be customized to fit the specific needs of each patient.

In conclusion, getting your orthotics covered by insurance can be a complex process, but it is worth the effort to improve your foot health and reduce pain. Be sure to check your insurance policy, get a prescription, choose a provider, submit a claim, follow up, and keep detailed records. Advocate for yourself if necessary, and explore your options for financial assistance. With patience and persistence, you can get the orthotics you need to live a more comfortable and active life.

Frequently Asked Questions

What are Orthotics?

Orthotics are medical devices that are designed to support and correct the structure and function of the feet, ankles, knees, hips, and lower back. These devices are made from a variety of materials, including plastic, foam, and carbon fiber, and are customized to fit the specific needs of each patient.

Orthotics can be used to treat a variety of conditions, including plantar fasciitis, flat feet, bunions, and arthritis. They can also be used to prevent injuries and improve athletic performance.

Do Insurance Companies Cover Orthotics?

Insurance companies may cover the cost of orthotics, but this will depend on your specific policy and the type of orthotics you need. In general, insurance companies will cover the cost of custom orthotics if they are deemed medically necessary and prescribed by a doctor.

Before purchasing orthotics, it is important to contact your insurance company to determine what your policy covers and what out-of-pocket expenses you may incur.

What is the Process for Getting Orthotics Covered by Insurance?

The process for getting orthotics covered by insurance will vary depending on your insurance company and policy. In general, you will need to visit a doctor or podiatrist to have your condition evaluated and receive a prescription for orthotics.

Your doctor may need to provide additional documentation to your insurance company to demonstrate the medical necessity of the orthotics. Once your insurance company approves coverage, you can work with a specialist to have your orthotics custom-made and fitted.

What Type of Orthotics are Covered by Insurance?

The type of orthotics that are covered by insurance will depend on your specific policy and the medical necessity of the orthotics. In general, insurance companies will cover the cost of custom-made orthotics that are prescribed by a doctor and deemed medically necessary.

Off-the-shelf orthotics and over-the-counter inserts may not be covered by insurance, but it is important to check with your insurance company to determine what is covered under your policy.

What Should I Do if My Insurance Does Not Cover Orthotics?

If your insurance does not cover the cost of orthotics, there are several options you can explore. You may be able to negotiate with your insurance company to have the cost of the orthotics covered, or you may be able to find a less expensive alternative.

Many orthotics providers offer payment plans or financing options to help make the cost of orthotics more manageable. You can also explore government programs or non-profit organizations that may provide assistance for the cost of medical devices.

Are Orthotics Covered By Insurance?


In conclusion, navigating the process of getting orthotics covered by insurance can be challenging, but it is possible. By understanding your insurance policy, gathering necessary documentation, and working with your healthcare provider, you can increase your chances of getting coverage for the orthotics you need.

Remember to be persistent and advocate for yourself throughout the process. Don’t be afraid to ask questions and seek clarification if needed. With patience and diligence, you can successfully navigate the insurance system and get the support you need for your orthotic needs.

Ultimately, getting orthotics covered by insurance requires a combination of effort and patience. While it may take some time and persistence, the end result is worth it. With the right approach, you can access the orthotics you need to live a healthier, more comfortable life.

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