How do I qualify for diabetic footwear under the Medicare Program or other insurance?
- Have Medicare or other insurance that provides coverage for diabetic shoes and inserts
- Be under the care of a physician for diabetes
- Have at least one of several foot conditions associated with diabetes:
- Pre-ulcerative callus formation or
- Peripheral neuropathy with a history of callus formation
- Foot deformity
- Poor circulation
- History of previous foot ulceration
- Previous amputation of the foot or part of the foot
Most commercial insurance companies follow Medicare guidelines. Contact your insurance company directly to see if you qualify for therapeutic shoes under your insurance plan. Be sure to tell them you are diabetic.
Check to see if you are responsible for any co-insurance, have a co-pay, or have a deductible. If you have not met your deductible you may be responsible for 100% of the cost. All co-insurance or co-pays will be collected at the time of service.
What does the Medicare Therapeutic Shoe Program Cover?
Medicare (Part B) will cover 80% of the cost of the following per calendar year (January 1-December 31):
- One pair of extra depth shoes
- Three pairs of heat molded inserts or three pairs of custom fabricated inserts.
- If you have Medicare as your primary and you have a secondary insurance, there may be NO COST to you.
- If you do not have a secondary insurance you may be responsible for 20% of the cost. This will be collected at the time of service.
What if I have a different insurance?
Check with your insurance company to see if you have coverage for diabetic shoes and inserts. Confirm when the effective dates of your policy and how often you may receive shoes.
How Do I Get Fitted For Shoes?
- Contact your insurance company to see if you meet their requirements for coverage.
- Schedule an appointment for foot exam with your diabetic care physician. A face to face visit with your physician must be done within 6 months of receiving shoes and inserts.
- Request a prescription for diabetic shoes and inserts. A prescription and Statement of Certifying Physician for Therapeutic Shoes must be on file before shoes and inserts are dispensed.
- Contact Sole Remedy Foot Care to schedule an appointment to be evaluated and fitted for diabetic shoes.
Are foot orthotics covered by my insurance?
Every insurance plan is different and coverage can differ between plans within the same insurance company. Call your insurance company to find out if you have coverage for custom foot orthotics.
Check to see if you have both in and out of network coverage and if you are responsible for any co-insurance, have a co-pay, or have a deductible that must be met. If you have not met your deductible you may be responsible for 100% of the cost. All co-insurance or co-pays will be collected at the time of service.
Find out if you can submit claims for reimbursement if Sole Remedy is not able to directly bill your insurance company. Document any phone conversation you have with the insurance company including name of individual spoken to, date of call and confirmation number related to the details discussed.
If you do have custom foot orthotic coverage in your insurance plan you will need a prescription from your physician.
Sole Remedy Foot Care is a recognized and accredited facility through the American Board For Certification In Orthotics, Prosthetics, and Pedorthics, Inc.
Sole Remedy can help you with all of your foot care needs including diabetic shoes/inserts, hard to fit foot shapes and sizes, and shoe modifications.
Phone: 508-295-8800 or 855-FOOT RX 9 to schedule an appointment today!