Orthotic medicine is concerned with the design, manufacture and application of orthopedic footwear and orthotics. These aids are prescribed as medically necessary, to correct congenital or post-traumatic deformities and other severe foot abnormalities.Orthotics are corrective devices worn inside a shoe to support and align foot function. To qualify for coverage under your plan, they must be custom made of raw materials and crafted using a three-dimensional (3D) cast of the insured person’s foot.The following are not eligible for reimbursement:➢ Commercially made, over-the-counter products, even when labelled as “orthotic”➢ Insoles purchased for comfort rather than medical necessity➢ Inserts to be used specifically for sports or other physical activities➢ Expenses associated with cleaning orthoticsCustom-made orthopedic footwear is typically used to treat a congenital deformity, traumatic injury or a disease affecting the feet. To be eligible for coverage, they must be custom made of raw materials and crafted using a cast of the insured person’s foot. If permanent custom modifications are made to shoes manufactured and branded as orthopedic, they are also eligible for coverage. Mass-produced, off-the-shelf footwear, such as sandals, comfort footwear or walking shoes, are not eligible for coverage under your plan.Claim submission requirementsBe sure to include the following information with a claim for orthotics or orthopedic footwear:➢ Gait analysis/biomechanical evaluation➢ Detailed lab invoice indicating that the orthotics or orthopedic footwear are custom made➢ Description of the casting method/make and model of orthopedic shoe➢ Detailed paid-in-full receipt, including a breakdown of charges, date received and provider name andaddressWe may contact you if any of the required information is missing from your claim submission.
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