Insurance Coverage Questions

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Because of changes to the Privacy laws, we can not call your insurance for you to determine this.  We would recommend using this guide to call your provider, to ensure that you meet the guidelines for your particular plan.

Call your Insurance Company to inquire about the following for Orthotiics, Braces, Compression Stockings, etc.:

1) How much coverage do you have?

 Is it a percentage of the total cost, or a flat amount? Are you allowed to purchase more than one device if your coverage amount is high enough, or are you restricted to just one covered item per year? Many plans allow for only one orthotic or brace, but provide for multiple pairs of stockings.

2) When are you eligible? 

Some plans reset after 365 days have passed, some have a specific date that it resets on. If you purchase orthopedic goods before your next eligibility date, you may not get the coverage you expected.

3) Specific Plan Restrictions?

A) Many insurance providers now require a diagnosis (Dx) to be included on the prescription (Rx) from your Physician.  This means if you have a 'flat foot' that hurts, the prescribing individual should not just put 'orthotics for foot pain'. Instead, a prescription should read along the lines of: "bilateral foot orthotics for over pronation / pes planus".  'Foot Pain' is very subjective and too open to interpretation. 

B) Some insurance companies have restricted coverage for compression stockings, based on the what is called millimeters of mercury compression (mmHg). Ask what level of compression is required to be covered, as some plans only cover 30-40mmHg, where others may cover as low as 15-20mmHg.

C) Are you eligible for a custom fitted brace, or does your device have to be made 'from scratch'?  There is a significant difference in the cost for each type of device and it's best to know before you commit to purchasing.

Most insurance companies will require your practitioner to provide you with a Gait Analysis / Range of Motion test.  If the provider you are seeing can not produce this form, it is likely that they are not fully trained to be providing orthopedic services.  Each client receives a copy of their Gait/ROM test when they pick up their custom devices.

There is a difference between a 'customized' orthotic device and a truly 'custom molded' one.  Most insurance companies will not cover a pre-made or modified device.  There should be 'lab invoice' that details the materials and procedures used to create the device.  Albany Orthopedics will provide a copy of your lab invoice, to ensure prompt coverage.

At Albany Orthopedics we allow our clients to split their payments up into multiple units, to make treatment affordable and manageable. Upon completion of your payment, a final receipt with your dispense date will be issued to you for insurance or income tax purposes.