Q: Will my insurance cover Orthotic and Prosthetic services?
A: Most health insurance policies cover Orthotic and Prosthetic services. We are in-network providers for many insurance carriers. Each insurance policy is different and coverage for orthotic and prosthetic services can vary depending on the particular device. Please contact our office or your insurance carrier for your specific policy’s coverage, restrictions, and deductibles.
Q: What if I don’t have any insurance?
A: It is important to discuss this issue in advance so appropriate arrangements can be made. Assistance may be available through various state and county agencies for patients who qualify. Our office staff will help you find a source for help with payment. Payment plans that meet your budget may be available.
Q: Will Medicare cover orthotic & prosthetic services?
A: We accept Medicare. Medicare will pay 80% of the cost most orthotic & prothetic services after you have met your annual deductible. Supplemental insurance policies will generally pay the remaining 20%. If you do not have a supplemental policy, you will be responsible for the 20% that Medicare does not cover.
Q: I have a Medicare replacement policy. Will it cover O&P services?
A: Medicare replacement policies cover the same O&P services as Medicare. However, they usually require prior authorization. After an evaluation by a practitioner has determined the specific device you require, our office staff will contact your insurance company for this authorization. I generally takes a couple of days to receive the authorization. You will have a return appointment scheduled after we receive the insurance authorization. You will be responsible for the 20% that your insurance does not pay unless you have a second supplemental policy.
Q: Will Medicaid cover O&P services?
A: We accept Medicaid. However, Texas Medicaid does not pay for orthotics for anyone 21 years of age or older. Devices may require ‘prior approval’. If this is the case with your device, we will inform you prior to providing any services.
Q: What methods are available for patients to pay their accounts?
A: Cash, check, Visa, Master Card, Discover, private insurance, Medicare, Medicaid and approved Workers’ Compensation.
Q: How much will my orthosis/prosthesis cost?
A: We cannot give estimates on the cost of a device without evaluating what your specific needs are. The coding system used for O&P billing (established by Medicare, but used by all payors) has over a thousand codes. Specific ‘base codes’ describe various orthotic/prosthetic devices in their most basic/generic form. Additional codes are utilized to account for the additions that are needed to customize the device to meet the patient’s specific, unique functional needs.
Our Orthotists, Prosthetists and Pedorthists provide free, no obligation consultations and can help determine what will best meet your needs. Once that is established, an accurate set of codes can be determined to confirm your coverage.