Your benefits plan may cover custom-made orthotics if they’re prescribed as “medically necessary” to treat a diagnosed condition by an authorized specialist.
When properly prescribed and constructed, custom-made orthotics can reduce your pain and help you walk with greater comfort and support. Check your benefits booklet to see if you are covered.
To get a suitable custom-made orthotic, ask questions and keep yourself informed throughout the purchasing process.
Who’s authorized to prescribe and dispense custom-made orthotics?
Custom-made orthotics can only be prescribed by physicians, podiatrists and chiropodists. They diagnose whether an orthotic would be beneficial to your situation.
Your custom-made orthotics can be dispensed by a physician, podiatrist, chiropodist, orthotist or pedorthist.
The prescribers and providers are licensed and governed by either a provincial or national body and are subject to standards of practice. This, along with each body’s Code of Ethics, helps ensure their accountability and your protection.
For all Canadian provinces (except Quebec*), podiatrists, chiropodists, pedorthists and orthotists are recognized as foot care specialists.
What should an orthotic provider do?
After being prescribed an orthotic, you’ll need to visit one of the providers listed above for an assessment. A provider will guide you through an extensive evaluation to ensure an orthotic is the best option and that it’s properly designed.
You should expect the orthotic provider to perform the following:
- Medical history review:
A complete investigation and documentation of your medical history, symptoms and previous injuries. The provider will also take into consideration your lifestyle (occupation and activities) as well as your current and past footwear (fit, style, wear and pattern).
A hands-on evaluation of the lower limbs including foot structure, alignment, strength, range of motion, soft-tissue damage as well as identifying any abnormalities.
- Gait analysis:
The provider will observe you walking to identify accommodations or abnormalities (e.g. whether you favour one leg or the other).
- Orthotic evaluation:
The provider will determine treatment options and explain how the treatments will address your specific needs.
A proper cast is essential to create a truly custom-made orthotic as it ensures that your orthotic is made with all the contours and structure of your foot. Casting techniques include: foam box casting, plaster of paris slipper casting, contact digitizing and laser scanning. (NOTE: If footprints are taken on an inkpad or using your shoe size, then this is not considered casting and does not qualify as custom-made.)
For an orthotic to be paid by your benefits plan, it must be constructed from scratch and fabricated directly from your mould. You can expect at least one week between your initial assessment and your fitting appointments. Orthotics that are not manufactured specifically to your needs can result in pain by overstressing your muscles, bones and joints.
Custom-made orthotics should be fitted specifically for you and your footwear. The provider should evaluate how you walk while wearing the orthotics. You should also be offered a follow-up appointment within 2-6 weeks of receiving your orthotics.
The provider should educate you on things like breaking in your new orthotics, lifespan, and how they should fit. You should also be made aware of any warning signs that the orthotics are not working properly and instructed to return if you experience any problems.
What are some things to be aware of when buying an orthotic?
Here are some things to be cautious of when buying an orthotic:
- A provider should have the capacity to modify your orthotic.
- Exercise caution when considering the purchase of orthotics from exhibits at trade shows, home shows or sportsman shows. If there’s a problem with the orthotic, returning it could be a problem, not to mention they probably aren’t custom-made. Exercise caution when considering the purchase from kiosks or booths in malls, department stores or over the internet for the same reasons.
- Be wary of people who come to your home or conduct group screenings of employees or family members without a proper evaluation.
- “Two for the price of one” deals or “free giveaways” with your purchase are not allowed under the code of ethics that regulated providers and dispensers are bound by. Some providers will use these “freebies” to inflate the price of an orthotic.
- Be suspicious of any provider that can’t answer your questions clearly or gives vague and ambiguous answers.
- Question a provider who recommends your whole family could benefit from orthotics without having seen or assessed them individually.
- Custom-made orthotics for children under five are highly uncommon. Skeletal or soft tissue injuries that require orthotic treatment don’t usually present themselves until a person is older. If for some reason they do need an orthotic, a medical doctor or pediatric specialist must prescribe it.
- For all Canadian provinces except Quebec*, prescribers and providers should have the following designations in their titles:
- Physician – M.D.
- Podiatrist – D.P.M.
- Chiropodist – D. Ch. or D. Pod. M.
- Pedorthist – C. Ped. (C). or C. Ped. (M.C.)
- Orthotist - C.O. (C) or C.P.O. (C)
- Question a provider who strongly recommends you see a doctor of his or her choosing for a referral instead of your family physician.
- If you feel pressured to purchase additional products or are uncomfortable with the business practices of the provider, consider another provider.
- Don’t ever give the provider a signed claim form.
Some of the examples listed above may not be relevant to your plan details. Check your benefits booklet for details.
*For the province of Quebec, a foot orthotist or an orthotist prosthetist working in a laboratory accredited by the Québec Ministry of Health and Social Services and who is a member of the Order of Professional Technologists of Quebec and a podiatrist are the eligible providers of orthotics.
How do I submit a claim for orthotics?
- Complete a claim online or complete the Extended Health Benefit Claim Form, include the following supporting documents, and send it to OTIP:
- Recommendation or referral, from a licensed physician, podiatrist or chiropodist, must include the medical condition requiring the use of orthotic appliances.
- Copies of the biomechanical examination and gait analysis performed.
- A description of the process used to create the orthotics including the casting technique and raw materials used.
- A receipt showing that the orthotics have been paid in full.
You will get your money back, or more information may be requested.
TIP: Before you spend the money, submit an estimate or pre-determination to see if your orthotics will be paid for. The process is very similar to submitting a claim.
For online estimates
For paper estimates
Click on the Log in button on the top right-hand corner.
Select Health and Dental from the drop-down menu.
After you have logged in, click on My Claims.
Click Submit a claim button and follow the steps to completion.
When you “Select service provider type,” scroll down to Other and select Estimate.
Be sure to write “ESTIMATE ONLY” on the form, attach your supporting documents and mail to the address on the form.
Source: Manulife GC2231E 04/2017