Commonly Asked Insurance Questions
Q: Will these shoes, inserts or modifications be covered by my insurance?
A: With so many different policies available, it is not possible to be certain what each insurance plan would cover; however, we can provide you with the billing code to make is easy for you to verify your coverage before proceeding with the services.
Q: How am I billed for the balance after billing my insurance?
A: We will bill your insurance first. They will then determine if this is a covered service and, if so, how much your co-payment will be. This information will be sent to you in the form of an Explanation of Benefits. We also receive a copy of the Explanation of Benefits. We will then bill you for the amount that your insurance company has determined to be your share of the cost.
Q: Do you have a payment plan?
A: If your insurance company denies the charges and they become your full responsibility, we will send you a maximum of four monthly statements giving you the opportunity to pay the balance. If, after the four statements, we have not received the balance in full, the account may be sent to collections. We do not have any standard payment plans; however, if you notify us immediately of your need for a payment plan, we will place your request under consideration. All payment plans require manager’s approval.
Q: Do you bill my insurance before I receive my inserts?
A. Copy to come…
Q: What if I change my mind after the inserts are made?
A: Inserts are a non-returnable and non-refundable item, whether they are custom made or an off the shelf product.
Q: How many pairs of diabetic shoes will Medicare pay for?
A: Medicare covers only one pair of diabetic footwear a year. They will also pay for three pairs of inserts, or six modifications to shoes, or any combination thereof that does not exceed a total of six separate inserts or modifications. The following information details Medicare’s exact requirements:
Information for Diabetics regarding Medicare coverage for Therapeutic Shoes and Inserts
If you are a diabetic with Medicare Part B and you meet certain conditions (see below), Medicare will cover therapeutic shoes if you need them. The types of shoes that are covered each year include one of the following:
1. One pair of depth-inlay shoes and three pairs of inserts or 2. If you cannot wear depth-inlay shoes because of a foot deformity, one pair of custom-molded shoes (including inserts) and two additional pairs of inserts. Note: In certain cases, Medicare may also cover shoe modifications instead of inserts.
In order for Medicare to pay for your therapeutic shoes, the doctor treating your diabetes must certify that you meet all of the following three conditions:
1. You have diabetes. 2. You have at least one of the following conditions in one or both feet:
• Partial or complete foot amputation
• Past foot ulcers
• Calluses that could lead to foot ulcers
• Nerve damage because of diabetes with signs of problems with calluses
• Poor circulation
• Deformed foot
3. You are being treated under a comprehensive diabetes care plan and need therapeutic shoes and/or inserts because of diabetes.
Medicare also requires the following:
1. A podiatrist or other qualified doctor must prescribe the shoes, and
2. A doctor or other qualified individual, such as a pedorthist, orthotist, or prosthetist, must fit and provide the shoes to the beneficiary.
3. A doctor must sign both the Therapeutic Footwear Statement and theOrthotic Footwear Prescription Card found here: Prescription Cards. Medicare helps pay for one pair of therapeutic shoes and inserts per calendar year, and the fitting of the shoes or inserts is covered in the Medicare payment for the shoes.
Q: Will my insurance company pay for shoes?
A: There are only two circumstances under which an insurance company will pay for shoes:
- If you are a diabetic.
- If your shoes are physically attached to a brace.
In both instances, your insurance company will need proper documentation to verify that you are a diabetic or to verify the medical necessity of having your shoe attached to a brace.
Medicare and Diabetes Patients.
Get your Doctor’s recommendation first so we can help you! Cover letter to your Doctor and CMN (Physician’s Certifying Statement & Prescription For Therapeutic Shoes) are available in the links below.