Did your health insurance cover your custom orthotics?
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I just got back from the foot doctor and was floored when they told me my insurance won't cover my custom orthotics. I genuinely have a great health insurance plan which I pay a lot for and I assumed they would cover medically necessary devices like this.
For those who have gone through this process, is it normal for even high-quality health insurance plans to completely exclude coverage for custom orthotics? What specific steps or appeals did you take if your claim was initially denied and did that work? They wouldn't even cover a portion of them, just the visit.
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Dr. William Naughton, DPM AdminChief Medical OfficerOfficial Account of Dr. William Naughton, DPM. As Chief Medical Officer, Dr. Naughton reviews discussions for medical safety and provides expert biomechanical insights based on 20+ years of surgical experience.It is very common for health insurance plans NOT to cover custom orthotics.
Even high-quality insurance policies frequently exclude custom orthotics from standard coverage, classifying them as non-essential or “comfort” items rather than medically necessary durable medical equipment.
Why Coverage is Often Denied
Most insurance providers determine coverage based on broad policy classifications rather than individual clinical need. As a result, custom orthotics are often categorized as elective devices, despite their proven role in managing foot pain, correcting biomechanical issues, and preventing further injury. This classification leads many plans to deny reimbursement, even when orthotics are prescribed by a healthcare professional.
Because of these limitations, patients are often surprised to learn that their insurance will not contribute to the cost. This can create a barrier to care, particularly for individuals dealing with chronic foot, ankle, knee, or lower back pain.
The Solution: HSA & FSA
That said, many insurance plans offer tax-advantaged alternatives such as Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs). These accounts allow patients to use pre-tax dollars to cover qualified medical expenses.
Since custom orthotics are a prescribed medical device, they are almost always eligible for these funds, which significantly reduces out-of-pocket costs.
Key Takeaways:
- Custom orthotics are often excluded from standard insurance benefits.
- Insurers frequently classify orthotics as non-essential or comfort items.
- HSA and FSA funds can typically be used to pay for custom orthotics.
- Using pre-tax dollars helps reduce the overall financial burden.
- Affordable access to medical-grade orthotics remains possible despite coverage limits.
