Navigating Insurance Coverage
- We handle insurance verification on your behalf, coordinating with payors to determine coverage limits and eligibility.
- We are contracted with most major plans—such as Medicare, Medicaid, United Healthcare, CDPHP, and more. If your plan is not listed, we will explore options to assist you. Also, sometimes insurance plans offer an Out-of-Network policy.
- Coverage typically includes custom orthotic and prosthetic devices when deemed medically necessary, as well as associated fitting, labor, and replacement procedures.
Billing & Payment Options
- You can pay easily with Visa or Mastercard.
- We offer patient financing options (e.g. CareCredit partnerships) to manage large out-of-pocket balances comfortably.
- Most custom orthoses are final sale; however, free modifications and adjustments are included for up to 90 days post-delivery.
Reimbursement & Out-of-Network Care
- Your insurance benefit determines final cost-sharing—expect to pay co-pays or deductibles as needed. We will verify your coverage beforehand.
- If you are out-of-network, you may owe more—but we will submit claims and help pursue reimbursement where possible.
Coverage & Policy Insights
- Orthotic coverage varies across insurers, but many plans—especially for Medicare Part B, Medicaid, or employer-sponsored policies—cover medically necessary devices.
- Medicare typically reimburses 80% of approved costs after deductible, while Medicaid and commercial plans follow plan-specific benefit terms.
Why Choose Prosthetics & Orthotics Designs?
- Dedicated billing staff supports you from consultation to delivery—and through claims or appeals.
- Clear communication on expected costs, financial responsibility, and coverage options—empowering your decisions.
- Flexible payment arrangements and support navigating prior authorizations and appeals.