Cooperators Orthotic Criteria
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 orthotics
Custom-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 requirements
Be 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 andaddress
We may contact you if any of the required information is missing from your claim submission.
To lean more, call 1-800-667-8164. Alternatively, speak with Beneplan to set up a call with us.