Insurance Claims for Footwear, Custom Made Orthotics & Compression Stockings

Extended Health Insurance Companies want to ensure their customers are receiving care from a qualified provider who follows standards set out by an association regulating these providers. Certified Pedorthists, belonging to this association are regulated by both this association and their credentialing body.

Every insurance company differs in the services they cover, however, when it comes to deciding whether claims for pedorthic services meets the standards they have for their customers, here are a few guidelines:

1. Ensure the client submits a prescription from a recognized prescriber (ie. Medical Physician, Podiatrist, Chiropodist, Orthopedic Surgeon)
2. Custom made orthotics cannot be fabricated properly unless the patient first receives a biomechanical gait analysis. Ensure a copy of this exam is submitted with the claim.
3. Receipts for orthotics and orthopedic footwear should be itemized separately on the receipt.
4. Ensure the impression of the foot is 3 dimensional and casting method should be identified.
5. Ensure a biomechanical exam is performed by a Certified Pedorthist / Podiatrist / Chiropodist / Orthotist
6. A copy of the lab information including raw materials should be provided.
7. The assessment date, pick up date and date paid in full should all be clearly stated on the documentation.

Canadian Life and Health Insurance Association

Understanding Claims for Footwear and Orthotics

Receipt Best Practices

Report Insurance Fraud Directly to the Insurance Companies

All members of PFA Footcare Association (Canadian Chapter) follow the guidelines above as well as the Code of Conduct and Professional Responsibility for this association.