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Does Insurance Cover Diabetic Shoes

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What Is Open Enrollment And When Does It Happen

Diabetic Shoes at American Foot & Leg

Medicare open enrollment is a period of time in which individuals and families can enroll in health insurance coverage.

  • Medicare Open Enrollment: October 15, 2021 to December 7, 2021

Note: You can apply for Medicaid and the Childrens Health Insurance Program any time of year. If you qualify, you can enroll immediately.

Does Medicare Cover Neuropathy Shoes

Neuropathy shoes help reduce the pain in your feet caused by neuropathy. Also known as orthotic shoes, they bring relief to many.

A common question about them is does Medicare cover neuropathy shoes? We answer this question below and also provide average costs or neuropathy shoes and other helpful info.

Prosthetic And Orthotic Items

Orthopedic shoes only when theyre a necessary part of a leg braceArm, leg, back, and neck braces , as long as you go to a supplier thats enrolled in MedicareArtificial limbs and eyesBreast prostheses after a mastectomyOstomy bags and certain related suppliesUrological suppliesTherapeutic shoes or inserts for people with diabetes who have severe diabetic foot disease.

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Supply For Women Who Have Diabetes

For women who already have diabetes before they are pregnant or have developed gestational diabetes during pregnancy, it is crucial for you to carry a medical ID bracelet with you at all times. In case of premature birth, your doctors will take into account of your blood glucose fluctuation and provide you with a safer childbirth option to lower the risk for both you and the baby. At the same time, the medical team can better anticipate various symptoms your baby may exhibit after birth and provide better care for him or her.

One of the common complications that diabetic pregnant women suffer from is swelling of the legs and feet. To counter that problem, your doctor may recommend medical compression sock for your needs.

Are Diabetic Shoes Covered By Insurance

Diabetic Shoes

If youve heard of sugar and love the sweet substance, then chances are youve also heard of a not so sweet condition that can accompany it.

Its none other than diabetes, which currently impacts more than 34.2 million Americans. To give you a larger perspective on how pervasive it is, more than 1 in 10 people in the country have it. That number doesnt include the 88 million Americans who are at risk of prediabetes.

Apart from it affecting your thirst and hunger among its list of symptoms, one of the most major ways it canimpact your lifestyle is in your feet. Because diabetes tends to damage your nerves, you might begin to lose some feeling in your two long limbs. This can lead to further complications when it comes to a reduced inability to heal or ward off an incoming infection.

Even though you might have never predicted that the innocent looking white powder could have caused your feet to lose their senses, it doesnt mean that you should give up when it comes to treatment and healing.

Thats where diabetic shoes can play a big therapeutic role in reducing the pressure that your feet have to tread with on a daily basis. They can additionally provide a cushion with ample support so that you can go about your life on your own two feet as usual.

However, like all durable medical equipment , their benefits come attached with a hefty cost. What youll usually see for diabetic shoes is a range of $50-200 per pair.

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To Find A Supplier/qualified Provider For Your Shoes And Inserts

If your treating physician doesnt point you in the right direction, here are some tools to locate qualified providers/suppliers for your shoes and inserts.

To find a Podiatrist you can use the locator tool on the American Podiatric Medical Association website here.

To find a Pedorthist you can use the locator tool on the Pedorthic Footcare Association website here.

To find a Prosthetist you can use the locator tool on the Prosthetist Finder website here.

To find an Orthotist you can use the locator tool on the American Board for Certification in Orthotics, Prosthetics and Pedorthics here.

Obviously, you can use the last locator to find Pedorthists and Prosthetists as well as Orthotists.

Remember to only use Medicare-approved suppliers and those who accept assignment !

What Type Of Shoes And Inserts Does Medicare Give Coverage To

If you have Medicare Part B and you have met all the Medicare conditions to qualify for shoes and inserts for diabetes,

The types of shoes that are covered each year include one of these:

  • One pair if depth-inlay shoes and 3 pairs of inserts
  • One pair of custom-molded shoes if you cant wear depth-inlay shoes because of deformity, and 2 additional pairs of inserts

Note: In certain cases, Medicare may also cover separate inserts or shoe modifications instead of inserts.

The source of the text is again Medicare Coverage of Diabetes Supplies, Services, & Prevention Programs which you can read or download here.

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What Coverage Does Medicare Offer For People With Limb Loss Or Limb Difference

Medicare Part B covers these items as durable medical equipment :

Who is eligible?

All people with Medicare are covered.

Your costs in Original Medicare:

You pay 20 percent of the Medicare-approved amount. Medicare pays for different kinds of DME in different ways. Depending on the type of equipment, you may need to rent the equipment, you may need to buy the equipment, or you may be able to choose whether to rent or buy the equipment.

Medicare will only cover your DME if your doctors and DME suppliers are enrolled in Medicare. Doctors and suppliers have to meet strict standards to enroll and stay enrolled in Medicare. If your doctors or suppliers are not enrolled, Medicare will not pay the claims submitted by them. It is also important to ask your suppliers if they participate in Medicare before you get DME. If suppliers are participating suppliers, they must accept assignment. For more information on this, visit the Your Medicare Coverage page.

If suppliers are enrolled in Medicare but are not participating, they may choose not to accept assignment. If suppliers do not accept assignment, there is no limit on the amount they can charge you.

What Equipment Does Medicare Cover

Are Diabetic Shoes Covered By Insurance?

The type equipment that Medicare covers for use in the home is called durable medical equipment, or DME.

For an item of medical equipment, or of medical supplies, to qualify as durable medical equipment it must

  • be able to withstand repeated use over a period of time durable
  • be for a medical reason only not for comfort
  • useful to someone who is actually sick, and of little use to a person who is well
  • be primary for use in the home
  • have a lifetime of at least 3 years

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Why Does My Insurance Company Not Pay For My Custom Orthotics

In most situations when the insurance premium is partially paid by the employer, the employees and their dependants are subject to the provisions written in their plan documents. Each employee has a right to a full length copy, usually 100-200 page plan documents that disclose the employer’s specific coverage limitations.

Many employers have excluded custom orthotics as a covered benefit, as a way to save their company the out of pocket expense of a custom item.

More recently due to a number of state mandates, employers are modifying the language of their benefits to include orthotics for certain medical conditions .

Currently Medicare interprets custom orthotics as a preventive service and therefore does not cover the custom item, unless it is an integral part of a brace. Medicare will cover diabetic shoes and inserts annually, but only if the patient meets strict requirements. For more information on Medicare coverage of diabetic shoes, contact us at Healthy Steps.

If you would like more information about orthotic coverage, please contact our Business team for more personal information. Remember that “medically necessary” does not always mean “covered by my insurance”.

Does Medicare Cover Orthotics For Weight Loss

According to the Hospital for Special Surgery , orthotics can help ease the extra stress on the feet for overweight people. Medicare does not cover orthotics for people who are overweight just because they are overweight.

Medicare may cover weight loss services such as surgery and/or nutrition counseling for people who qualify. Some Medicare Advantage plans even cover fitness programs!

You may also be able to get over-the-counter benefits with some Medicare Advantage plans. So, even though you may not qualify for prescription orthotic coverage, you may be able to find coverage for over-the-counter products you can find at your local drugstore or mail-order pharmacy.

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About The Supplier And Assignment

You must make sure that the supplier, who will be from one of the listed professions above, is Medicare-enrolled, and that they are a participating supplier.

If they are not Medicare-enrolled, you will not receive coverage.

If they are not a participating supplier this means they do not accept assignment, which is the Medicare-approved price, and can charge much more than a participating supplier who accepts assignment, so do verify that with them.

Medicare Reimbursement: An Explanation Of Benefits

Interestingly, patients do not need to pay for diabetic ...

Nearly 30 million Americans have diabetes, according to the Center for Disease Control. In fact, studies suggest prescription diabetic footwear can help prevent serious foot health complications that can arise because of diabetes.

Medicare and supplemental insurance may reimburse part or all the cost of Dr. Comfort shoes and prescription inserts for diabetics who meet certain criteria. A qualified health professional can determine if eligible. If diabetic or have any foot health concerns, we strongly encourage the patient to see a foot health professional to address all foot health needs.

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Why Are Foot Orthotics Not Covered By Insurance

Many employers have excluded custom orthotics as a covered benefit, as a way to save their company the out of pocket expense of a custom item. Currently Medicare interprets custom orthotics as a preventive service and therefore does not cover the custom item, unless it is an integral part of a brace.

Shoe Modifications And Replacements

Medical necessity criteria for replacements of or modifications to existing customized shoes is based on the same criteria noted for the shoe itself. Replacement of a pair of shoes, or modifications, should be based on necessity , not for convenience or style change. Due to wear and tear with normal use, orthotics may need refurbishing periodically, every 1 or 2 years. Replacement of orthotics is generally not necessary more often than every 2 years.

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Who Prescribes The Shoes And Inserts

The shoes and inserts must be prescribed by a Podiatrist , which is a foot doctor, or other qualified healthcare provider these may be a physician assistant, nurse practitioner, or clinical nurse specialist.

Once you have the Statement of Certifying Physician from the physician who is treating you for diabetes, you then need to see a podiatrist or other qualified health care provider for the correct prescription.

The Prescribing Practitioner is the one who will write the order for the therapeutic shoes, modifications and inserts.

Again, please remember that the Prescribing Practitioner the Podiatrist, or other qualified healthcare provider, who gives you the prescription for the shoes and inserts must be Medicare-enrolled, otherwise you will not receive your Medicare coverage.

Supplies For Specific Diabetic Complication Needs

Diabetic shoes covered by Medicare

In addition to the general list of supplies that all diabetic patients must need, there are various supplies that are also common for people with more severe cases of diabetes:

  • Urine Test Strips for Measuring Ketone Level

The ketone test strips are available at your pharmacy should your doctor recommends it to keep your ketone level in check.

  • Insulin Pumps

If you require an insulin pump due to various reasons, your doctor will prescribe it for you. You will be responsible for paying 20% of the Medicare-approved amount after your yearly Medicare Part B deductible. Please note that Medicare will also pay for the insulin that is used with the insulin pump.

  • Therapeutic Shoes or Inserts

If you are enrolled in Medicare Part B and suffer from diabetes, Medicare will cover the cost of therapeutic shoes or inserts if you meet these conditions:

  • Partial or complete foot amputation
  • Past foot ulcers

You will be allowed to choose one between these two options:

Please note that Medicare will only cover these two types of therapeutic shoes and inserts. General therapeutic shoes and inserts are not covered.

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Dont Leave A Diabetic Shoe Order To The Last Minute Order Before The End Of November

Many people choose to order their diabetic shoes from at the end of the year. This can be strategic those who get shoes in October or November have to wait less time to order their next pair of Medicare-covered shoes, since their coverage restarts again in January. Other times, its less about strategy and more the result of forgetting or putting off ordering until the end of the year.

Whatever the reason, waiting until October or November to place an order is a common choice, but ordering any later than that may place the order in the next calendar year. Why? Because there are several steps required to obtain Medicare coverage, all of which need to be completed within the calendar year in order to finalize the claim.

For those who place an order for shoes after mid-December will have their order shipped and billed in January. As a result, their final Medicare claim will fall under the following calendar year.

What Is The Therapeutic Shoe Bill

Congress passed the TSB or diabetic shoe benefit a while back. Ever since the bill was passed, Part B provides reimbursement for therapeutic shoes, inserts, and modifications for beneficiaries with diabetes who meet specific eligibility requirements.

You may be eligible if you have diabetes, documentation from a qualified physician, and at least one of the following:

  • Amputation of all or part of either foot
  • Foot deformity
  • Diabetic neuropathy with evidence of callus formation

If youre unsure about your eligibility, you can contact a Medicare representative.

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Diabetic Shoes Are Covered By Most Insurance Companies

Mar 13, 2014 | News

According to Medicare Part B covers one pair of therapeutic shoes and inserts as durable medical equipment , and the fitting each calendar year. Every calendar year!!! Most other insurance companies have followed Medicares guidelines for Diabetic therapeutic shoes with either custom fit or custom made foot orthotics.

How much did you just spend for your last foot orthotics? Theyre generally covered at 80% and most insurance companies will cover 3 pair to go along with your new shoes!

for an appointment to have your feet evaluated for either custom or OTS therapeutic shoes with inserts.

Why Are Diabetic Shoes Important

Does Medicare Cover Diabetic Shoes?

Diabetics may suffer from diabetic neuropathy. This type of nerve damage may make feet vulnerable to injuries in a few different ways, according to the National Institutes of Health:

  • Injuries may take longer to heal because of restricted blood flow.
  • Affected limbs may lose sensation, so its more difficult to detect an injury and get it treated promptly.
  • If you lose feeling in your feet, an unnoticed injury can lead to an infection.

The Centers for Disease Control suggests quarterly foot exams for diabetics. In addition, the agency recommends a good regimen of home care. This includes keeping feet clean, inspecting feet for injuries, keeping toenails carefully trimmed, and wearing the right socks and shoes.

In addition to neuropathy, complications associated with diabetes may even change the shape of the patients foot and weaken the muscles. The National Institute of Health, or NIH, recommends checking with a doctor about special diabetic shoes and/or shoe inserts. In some cases, diabetics may need custom-made shoes to provide extra protection.

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How To Get Orthotics Covered By Insurance

Now for this article I am going to attempt to make it ideal for both a doctor or for a patient who wants to know if they can get the orthotics covered. Custom Orthotics are expensive, ranging anywhere from $300-600. In some cases they are more expensive than some minor surgeries, so getting insurance companies to cover them would probably be a good thing. It reduces cost to the patient and allows the doctor to collect a decent profit. For the vast majority of cases orthotics can improve a condition from Plantar Fasciitis, Achilles Tendonitis, Flat feet or just chronic foot pain.

Now the first answer to getting orthotics covered is for the physician to document, document, document. The more treatments you can document the greater chance of getting the insurance to cover orthotics for the condition. For example, if the patient has Plantar Fasciitis, if the physician has documentation of cortisone shots, stretching routings, physical therapy, night splints, etc., that will greatly increase your chances of getting them covered. In other words, if you show up on your first visit and expect custom orthotics to be covered you are nuts. Listen, there are doctors that will try and they will fail to get them covered and the patient will be stuck with the bill. That is actually okay though. Custom Orthotics can be an effective treatment. If the patient does not mind spending the money then by all means spend the money.

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