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The Advice Centre

What you need to know about claiming footwear and orthotics?

Tuesday, January 13, 2015
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Insurance Basics, How to make a claim

What you need to know about claiming footwear and orthotics?

If you’ve been prescribed foot orthotics or orthopaedic shoes there are a few things you’ll need to know before you make your purchase and file your claim. Let’s get started.

First, you’ll want to make sure these are covered benefits under your health plan. You can check your coverage through your insurance provider’s website.

Orthotics and orthopaedic shoes are typically only eligible for coverage if they meet the following requirements. They must be custom-made from raw materials using a three-dimensional cast of your feet. They must be prescribed by an eligible health provider. The specific type of provider may vary depending on your plan.

Custom-made orthopaedic shoes are covered for congenital medical conditions such as someone born with a foot deformity or as a result of a traumatic injury.

Some examples of what’s not covered include commercially made products sold over the counter like cushioned heel cups or insoles, orthotics made by walking over a pressure pad, orthotics used only for sports or recreational activities and any off the shelf footwear like sandals, which are purchased for comfort.

So in summary, when making your claim you’ll need to provide the following information before coverage is considered.

  • You’ll need to provide a copy of your prescription outlining the medical diagnosis from an eligible health care provider.

  • You’ll also need to submit a lab bill that includes details of the casting technique used. Confirmation from the person who made the product that raw materials were used.

  • For custom-made foot orthotics, you’ll also be asked to provide a copy of a biomechanical assessment or gait analysis.

Your insurer may have specific requirements for orthotics and orthopaedic shoes so always look or ask for specific claiming instructions before you make your purchase. You’ll find claiming instructions for orthotic and orthopaedic shoes covered by Blue Cross on our website. The more you know, the more you’ll benefit from your health coverage.

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