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Insurance Requirements for Orthotics

We ask that prior to having your Orthotic assessment at the clinic with Dr. S Hollis that you inquire into your Insurance requirements for the cost’s to be covered.  We do not take responsibility for unpaid claims should you not meet the requirements of your plans/benefits.

Below is an example from an insurance company and what they require of patients making an Orthotic Claim.

Claims include coverage for footwear that is:

  • Custom made orthopedic shoes; footwear made specifically for one patient, from raw materials using varying measurements or three-dimensional casts of the foot/feet.
  • Off the shelf(pre fabricated) orthopedic shoes; footwear with specific orthopedic fit and function made from raw materials for patients.
  • Custom fitted or modified orthopedic shoes; a shoe is considered to be modified when it is permanently changed  by adding rocker soles, leather patches or lifts to accommodate foot deformity’s
  • Custom made foot orthotics; a device made from the cast of a foot/feet that is then inserted into the shoe to support, align, prevent or accommodate foot abnormalities and improve foot functioning.

Setting the Standards

Prescription requirements again vary from each insurance company and we ask again that you look into your personal coverage plan.   These are the requirements set out by the Canadian Life and Health Insurance Association Inc. (CLHIA) which sets standards for most Health Insurance companies;

  • a completed signed and dated claim form
  • a copy of prescription written by an eligible health practitioner indicating; patients diagnosis necessitating the use of orthotics, a copy of a detailed biomechanical examination, stance and gait analysis, details of casting technique used.
  • an official receipt issued by the dispensing practitioner with; name, address of provider, detailed description of the types of orthotics provided to patient, a breakdown of the charges, the date full payment was received for the charges and the date the product was received.

Our friendly knowledgeable staff will be happy to assist you if we can in making your claims with ease, we also provide you with a copy of any of the above requested information for you to submit to your insurance company.