I have BCBS what are the chances of orthotics being covered by it?

Question

i have alot of leg problems beacuse i have flat feet & i over pronate.. i dunno if my heels being everted(sp?) is the same thing. anywho i have achilles tendinitis and patellar tendinitis and maybe a hip problem. i have been going to pt for 3 months now and no improvements have been seen. either way my insurance is going to have to give me more visits or cover my orthotics.. which one is more probable?

Answer 1

Well, you need to read your plan to see what's covered.  If the orthotics are deemed medically necessary, they might be covered.  But "giving more visits" is NOT going to happen.  The coverage limits are exactly that - limits.

Answer 2

Each insurance is different, even BCBS has different plans so it is hard to say. Your parents should have a book that lists benefits of your plan. Usually, with a dr's prescription, they will pay for them. You may have to pay a portion of them, but if they are medically necessary and you have a prescription for them, insurances are usually obligated to pay for them. What's so silly about them not paying for them is the fact if you don't get them now, your problems will worsen over the years to the point that it will cause your whole body to be out of alignment. If your insurance doesn't pay for them, at the very least, get arch supports to put in your shoes.

Flat feet can cause major problems. You are very knowledgeable about your condition. When you have no arch, your foot turns inward (pronates) and since your hind foot (heel) tries to compensate for that, it therefore everts (turns outward). You can probably look at the bottom of your shoe and see that the inside part of your shoe is much more worn than the outside. Even if you think PT is not helping now, it will over time and this is probably exercises you will have to do for the rest of your life unless you would happen to have surgery. One of the most important things you need to do is stretching, particularly for ankle supination and inversion of your heel. Your muscles are probably already tight and with you stretching in physical therapy and at home, this will help greatly. But many, many people live with flat feet and orthotics or arch supports will greatly help your condition. Good luck to you!

Edit: The insurance agent above is absolutely correct. Each insurance plan has a maximum number of therapy visits they will pay for in a year. It doesn't matter if you need more, most people do, that's it and no amount of arguing will make a difference. If I was your PT, I would have just seen you 3-5 visits initially to teach you and your mom a home exercise program, let you do it for a couple of months and then see how you were doing. That way you would still have plenty more visits if needed. But that shifts the responsibility to you, you will have to do your home exercise program. Now, if your visits are out, you'll have to just continue to do the home exercise program on your own anyway. You can do it though! It will help matters greatly. If you need anything that I could help with, email me and I'll help in anyway I can.