I have had foot problems for as long as i can remember. Not only are my feet extremly flat, but I have tendencies for morton's neuromas, several plantar fascitis, and severe heel pain. I have been told by several podiatrists that I need to wear orthotics to alleviate my pain. Lately the pain has gotten so bad that my doc says that i'm developing arthritis due to the bones in my foot fusing together and tarsal tunnel syndrom because the tendons on the back of my calf or getting so tight. Heres the thing I was so sure that my insurance would cover the costs of the orthotics because of the severity of the medical necessity. Well I called my insurance (Wellpath) that won't cover the orthotics unless I have diabetis. This is so bs its makes me made. They won't pay for $340 for orthotics but they will pay for a thousands of $'s of surgery that I'll have if I dont' get the orthotics. I spoke with my doc he agrees with me and will write a letter of appeal. I have a good feeling that i'll probably end up paying for them but I'll fight to get that stupid insurance company to pay for it.
You may want to get another opinion about your foot problem. It really may be too late for orthotics. Get them ASAP and try, however getting another opinion is called for as well. You may pay for that too. Find someone who has ALOT of experience in foot and ankle deformities and reconstruction. Depending on where you live I may know of a specialist. I think it's amazing that you don't already have orthotics and your problems are so advanced. The problems you describe are extreme and worse than what I had - I had orthotics for several years and the pain kept getting worse. Reconstructive surgery was my only remaining option - a scary one - but VERY necessary and effective. (I'm 31 years old) Such severe dysfunction in your feet over time will lead to ankle, knee, hip and back problems. I truly feel that my foot surgeon saved my life and hopefully saved me from a future knee and/or ankle replacement. Please get another opinion - and keep us "posted".
My insurance doesn't cover orthotics, and it's truly ridiculous. I had PF surgery because they wouldn't pay for orthotics, but they would pay for the surgery. Since the DPM severed a nerve, I had to have subsequent therapy, testing, and treatment. Including hospital stays, tests, consultations, therapy and more, they have paid out close to $80,000. Still, when my OS ordered $75 ortotics, they still won't cover them! It will be difficult to convince them to pay, so here is my suggestion--start with something off the shelf, which will cost about $75. If you get them from a good place, they can often help you customize them, or a good DPM would also. If $75 ones can be of significant help, you've saved a few hundred bucks, and if not, many DPMs and companies will let you trade up--apply the $75 to the purchase of more expensive custom ones.
File a grievance! I did and they paid for it. Simply write them a letter explaining why you need them. it's obvious you do. GOOD LUCK to you.
Breast Cancer Survivor 12/09 -Stage 1-Grade 3- IDC. ER-/PR-/Her2+. Neck Surgery - ACDF C6/C7 11/08. Bladder Surgery-Burch Procedure 2/06. THE LAST FIVE YEARS HAVE BEEN NOT SO MUCH FUN!
My last insurance paid for orthotics for my son but my current one won't pay. I'm going to need them too ($425) but they have paid a ton of money this year so far in surgeries (2 bunions, 2 hammertoes and a neuroma). I'll try the grievance route too greenacres!! Thanks....
I have worn orthodics for about 6 years- custom from the doctors. I have had three pairs plus an additional left one because after each surgery my foot changed. I was very fortunate that my insurance has paid for all of the pairs. My mom works for a different insurance company and she tells me that the do not cover them.
I would try and file an appeal. Maybe with the doc on your side it will carry some weight. Good luck!