Not all medical products are covered by every insurance plan.

A healthcare practitioner recommending a product does not automatically mean that your insurance provider will reimburse you.

Insurance plans may have different requirements regarding:

• Rigid vs. soft braces

• Custom vs. off-the-shelf products

• Medical vs. athletic use

• Medical necessity vs. comfort or convenience

• Prescription requirements

• Eligible healthcare providers

• Maximum reimbursement amounts

• Pre-approval requirements

Our recommendation: call your insurance provider BEFORE purchasing.

Ask:

"Is this product covered under my plan?"

"Do I need a prescription?"

"Does the prescription need to include a specific diagnosis?"

"Does the prescription need to come from a physician?"

"Do I need pre-approval?"

"Is there a maximum amount covered?"

A quick phone call by the actual plan holder before purchasing can help prevent unexpected out-of-pocket expenses!

Many extended health insurance plans require a prescription or written recommendation before they will reimburse medical products.

For the best chance of a successful claim, your prescription may need to include specific information.

Orthotics

Your prescription should include your actual diagnosis. A prescription that simply states "orthotics" may not be sufficient for some insurance providers.

Example: Custom orthotics for treatment of plantar fasciitis.

Compression Socks, Stockings & Sleeves

Your prescription should include:

• Your diagnosis

• The recommended compression level

• At least 20–30 mmHg, when clinically appropriate

Your insurance provider may have additional requirements.

Braces

A prescription or written recommendation should ideally include:

• Diagnosis or medical condition/injury

• Body part requiring support

• Specific brace/device being recommended

• A statement that the brace is medically necessary

Keep a copy of your prescription for submission to your insurance provider!

Dr. David Blair will assess your condition, symptoms, functional limitations and individual needs for clinical documentation.

For custom orthotics, he uses a 3D Foot Scanner and Gait Analysis as well as diagnostic testing in clinic.

For custom braces and compression products, he will take the appropriate measurements needed for the product and its intended use.

You will discuss the product options available and recommend the most appropriate option for you.

David will order your product and you will receive an itemized receipt from the clinic with all necessary information for submission to insurance.

Your receipt should include information such as:

• Patient's name

• Date of purchase

• Clinic/business name and address

• Description of the product

• Make/model, when applicable

• Whether the product is custom or prefabricated

• Individual cost of the product

• Taxes

• Total amount paid

• Proof of payment

You can use this documentation when submitting your claim to your insurance provider.

Depending on your insurance provider and individual plan, you may be asked to provide additional documentation from your healthcare practitioner. David will provide this along with your detailed receipt.

This may include:

• Assessment findings

• Diagnosis

• Why the product is medically necessary

• Functional limitations

• How the product will assist with treatment, mobility, stability or function

• Expected duration of use

This can be particularly important for custom or higher-cost products.

Please note that patients are financially responsible for the full cost of their medical product.

Insurance reimbursement is not guaranteed and is determined by your individual insurance provider and benefits plan.

Before your product is ordered, a credit card must be kept securely on file.

Once your product is ordered, your card will be charged for the full cost of the product, regardless of whether or when your insurance provider reimburses you.

We recommend confirming your coverage and any prescription or pre-approval requirements with your insurance provider before placing your order.

Flow Physio + Wellness is happy to provide the appropriate clinical documentation available to us to support your claim however, we cannot guarantee insurance reimbursement.

Our clinic admin will notify you when your product is ready to be picked up and if appropriate, will schedule you for a free fitting appointment with David to ensure the education and use is discussed.