Custom-Made Orthotics
A custom-made orthotic is a removable foot-care device that can be discreetly inserted into the shoe to support, align, prevent and/or accommodate foot abnormalities and improve how the foot functions.
Used in conjunction with appropriate footwear, custom-made orthotics can be effective in helping to treat a number of lower limb and foot problems. They can also help you walk with greater comfort and support.
Custom-made orthotics must be:
- Medically necessary and prescribed by a qualified provider as outlined under your Extended Health Benefits plan.
- Fabricated from raw materials using a three-dimensional (3-D) cast impression that captures the anatomy and contours of the plantar aspect of the patient’s foot.
- Fabricated by a qualified professional.
- Orthotics that are off-the-shelf or prefabricated are not eligible.
- Orthotics must be fitted and dispensed by a qualified professional where it is permitted and within their scope of practice to do so.
Claims reimbursement will be subject to applicable plan maximums, deductibles, and limitations as defined under your benefits policy. Please refer to your employee benefits booklet and/or your insurance carrier for coverage.
Prescriptions should include the following:
- A diagnosis that outlines the medical condition that necessitates the use of custom-made orthotics.
- Be prescribed by a health care professional in good standing with their provincial regulatory body.
For custom-made orthotics, claim documentation should include a clearly documented invoice and supporting documentation, including the following:
- The casting method used to create the orthotic (should be 3D volumetric) and the date of the initial assessment/casting.
- Date the orthotics were produced, dispensed, and paid in full.
- A copy of the biomechanical exam and gait analysis. The results of the analysis should be included in the claim submission.
- Confirmation of the name and qualifications of the person who dispensed the custom-made orthotics.
If the orthotics were constructed in house by the provider, the following must be included in the claim submission:
- Confirmation of the name and qualifications of the foot specialist that constructed the custom-made orthotics.
- A description and breakdown of the raw materials used in the production of the custom-made orthotics.
If orthotic production is outsourced to a third-party laboratory, the following should be included in the claim submission:
- A copy of the laboratory invoice and shipping documentation from the third-party laboratory to the approved provider.
- The name and qualifications of the person who produced the custom-made orthotics.
- A description and breakdown of the raw materials used in the production of the custom-made orthotics.
