Custom Orthotic Care for ID
Custom Orthotic Care in ID
We understand how joint pain and weakness can limit your enjoyment of activities, which is why we strive to provide a solution that works for you. You deserve to have orthotic care that meets your needs. You can count on the team at OrthoPro to listen to your concerns and do our best to exceed your expectations.
We strive to make obtaining custom orthotic devices a pleasant and exceptional experience. Our team will work with you to find the best solution, and we’ll work with your insurance company to ensure you receive the support you need. Learn more about our services or call 208-733-0505 to set up a free consultation.
We provide orthopedic bracing for the following conditions:
- Cervical Bracing
- Body Jackets
- Pain Reduction
- Upper Extremity
- Range of Motion
- Positional or Tension-Based
- Fracture Bracing
- Lower Extremities
- Functional and Unloading Knee Bracing
- Ankle and Foot Bracing
Custom Orthopedic Bracing
What To Expect During Your Orthotic Care
OrthoPro wants to make your experience being fitted with an orthotic device as easy and painless as possible. We are dedicated to you, our patients, and strive to provide the superior patient care that you deserve. Most orthopedic bracing is covered by insurance but there are some exceptions and limitations.
Working with Your Insurance Company
Insurance companies usually limit how often someone can get a new brace. For example, Medicare and most insurance companies limit replacement ankle bracing to one brace every five years. This is typical, even when the new brace is a completely different design from the first. An exception to this rule is when you experience a significant anatomical change, or if the first brace is broken in an accident, such as a car wreck.
Common Claim Denials
Unfortunately, it's normal for insurance companies to deny claims for all replacement bracing - even when the two braces serve very different purposes.
Here are a few examples of when it might be necessary to get a second brace within five years:
- You are provided with a healing boot at your post-surgery appointment.
- The boot is only intended for short-term use.
- Your doctor also prescribes a custom brace for you to use when the time comes.
- Your doctor submits a medical claim for the healing boot which is considered brace #1.
- Unfortunately, your custom brace will be considered brace #2.
- The claim for the custom brace will be denied by Medicare because it was provided within 5 years of the healing boot.
During the appeals process, we must submit proof of a medical necessity for the second brace. This process can take several months to years. The denials often continue even with strong evidence of necessity.
Our Efforts to Help
At your first appointment, we will ask you about your brace history. It's important that we know about any bracing you have received, regardless of what type of bracing it was.
If you received any brace of any design for the body part we are treating, we will discuss this with you in detail. Additionally, we will:
- Request your doctor’s notes.
- Obtain your Medicare billing history for all bracing within the last 5 years.
- Evaluate your unique situation to figure out if replacement meets Medicare’s criteria for coverage.
- Consider asking you to sign an Advance Beneficiary Notice on Non-Coverage (ABN).
If your doctor does not include enough details in their notes to address the need for replacement, we will contact your doctor for more information. You may need to schedule an additional appointment with your doctor to ensure the required notes are completed correctly.
Actions You Can Take
Most doctors are not aware that temporary bracing solutions like healing boots count towards your 5-year bracing allowance. Although we are doing our best to educate the medical community about this issue, it's important for you to also educate your medical team. Prescribing professionals should:
- Specify why any brace is needed on their notes.
- Understand that replacement bracing is only covered due to significant anatomical and/or physiological changes or irreparable damage due to a specific accident.
- Be aware that we will likely request additional documentation from your doctor to support the need for replacement.
You can also contact Medicare directly at 1-800-MEDICARE to voice your concerns.