To ensure you get a suitable custom-made orthotic, it’s important to ask questions and keep yourself informed throughout the purchasing process.

Buying custom-made orthotics – what you need to know
If you’ve been prescribed orthotics it is important to ask questions and keep yourself informed throughout the process. This will ensure you get a suitable custom-made orthotic.

About custom-made orthotics
A foot orthotic is a prescribed medical appliance that fits into a person’s footwear. Custom-made orthotics are manufactured from a 3-D image of your foot using raw materials. When appropriately prescribed to treat a medical condition and custom-made, orthotics work on your feet much like glasses work on your eyes – they reduce stress and strain on your body by bringing your feet back into proper alignment.

Custom-made orthotics are prescribed by specific health-care professionals, which include physicians, podiatrists and chiropodists. They will diagnose whether or not an orthotic would be beneficial to your situation.

Many suppliers offer orthotics. For all Canadian provinces (except Quebec), podiatrists, chiropodists, and pedorthists are recognized as foot care specialists. 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.

What to expect during your assessment
After being prescribed an orthotic, you’ll need to visit a provider 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
• Examination of your lower limbs
• Gait analysis
• Orthotic evaluation to determine treatment options
• Casting of your foot
• Manufacturing of the orthotics
• Dispensing of orthotics and follow up
• Education on your new orthotics

Making a claim
Making a claim for orthotics is different from most other claims, as it requires specific information and additional supporting documentation to be considered eligible under your group plan. You will need to complete an Extended Health Benefit Claim Form, and submit it with the following supporting documents to OTIP:

• A referral from a licensed physician, podiatrist or chiropodist, showing the medical reason for the orthotics
• Copies of the biomechanical evaluation and gait analysis
• A description of how the orthotics were created, which must include:
  • casting technique
  • type of raw materials used
• A copy of the original receipt that shows:
  • the orthotics have been given out to you, or
  • you’ve fully paid for them

You will then be notified in writing by the insurer, Manulife, of the claim decision, or if additional information or an audit is required. Keep in mind that your coverage is for medically necessary custom-made orthotics. This means that things like orthotics footwear purchased for convenience or general comfort only, commercially-made products sold over-the-counter or orthotics for sports or recreational activities only are not covered under your plan.

Be cautious – things to be aware of when buying an orthotic
If you think you need orthotic shoes to treat a medical condition, take the time to look for a reputable provider to get a proper assessment and diagnosis. Things to be aware of when buying an orthotic include:

• Exercise caution when considering the purchase of orthotics from exhibits at trade shows, home shows, kiosks or booths in malls, department stores or over the Internet. If there’s a problem with the orthotic, returning it could be a problem, not to mention they probably aren’t custom-made.
• 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 may not be 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 strongly recommends you see a doctor of his or her choosing for a referral instead of your family physician.
• Question a provider who recommends your whole family could benefit from orthotics without having seen or assessed them individually, or suggests custom-made orthotics for children under five.
• Don’t ever give the provider a signed claim form. You are responsible for that claim submission and the only way to be sure of what is submitted is to complete it and mail it yourself.

Sources:
Buying custom-made orthotics – what you need to know (Manulife, GC 2231E 04/2016)
Orthotics, orthopaedic shoe and compression stocking claims (Manulife, GB 3906E 02/18)