Will my insurance pay for custom orthotics?

Many plans offer partial coverage for custom orthotics when deemed medically necessary, but how much, certain requirements, and limitations vary between providers. At Canyon Foot + Ankle Specialists in Twin Falls and Burley, Idaho, we accept many major insurance plans. Our podiatry team will gladly help you understand potential coverage options, but we always recommend contacting your insurance provider directly to verify your specific podiatry coverage before proceeding with custom orthotic treatment. Here’s what you should know. 

Understanding Custom Orthotics Insurance

These prescribed devices are sometimes—but not always—classified under "Durable Medical Equipment" (DME) by insurance companies, including Medicare Advantage. However, coverage classification differs depending on the insurer. In some cases, they might be categorized as orthotics, prosthetics, or even podiatry services. So review your policy requirements carefully to determine the correct classification, what percentage is covered, and whether prior authorization or a doctor's prescription is required.

Additionally, many plans require a letter of medical necessity from your podiatrist before approving orthotics insurance. At Canyon Foot + Ankle Specialists, we provide this documentation when clinically appropriate to support your insurance claim. 

Some policies might also limit replacement frequency to one pair every 1–3 years, or specify podiatry coverage only for certain conditions such as severe plantar fasciitis or diabetic foot complications. 

Most insurers want clarification between "custom" and "prefabricated" orthotics, too, and plans that deny coverage for custom devices often cover less expensive prefabricated options. Our Twin Falls and Burley podiatry specialists will determine which type best addresses your specific foot condition.

5 Key Questions to Ask About Your Podiatry Coverage 

If we’ve recommended custom orthotics treatment, contact your insurance company with these specific questions:

1. Coverage verification. Ask if custom foot orthotics are covered under your plan and what documentation is required. Request information about both in-network and out-of-network podiatry coverage for orthotics services.
2. Prior authorization. Inquire whether pre-approval is needed before one of our podiatrists prescribes and designs custom orthotics. Many insurers require this step before agreeing to coverage.
3. Out-of-pocket costs. Ask about your potential expenses, including whether your deductible applies to orthotic devices. Determine if podiatry coverage differs between therapeutic and functional orthotic solutions.
4. Annual limits. Check if your plan has a cap on devices. Some orthotics insurance policies restrict coverage to one pair yearly or set maximum contribution amounts.
5. Alternative coverage. If your standard medical insurance plan denies podiatry coverage, ask if you can use HSA or FSA funds for custom orthotics, as these accounts often cover medically necessary devices even when traditional insurance doesn't.

Reach out to our helpful staff at Canyon Foot + Ankle Specialists any time for more information we can provide so you can have a knowledgeable conversation with your insurance provider.