Medicare-Insurance

According to the American Diabetes Association, there are approximately 16 million Americans with diabetes. Twenty-five percent of persons with diabetes develop foot problems related to the disease. With numbers continuing to grow, Congress approved the Medicare Therapeutic Shoe Bill to help thousands of people with diabetes obtain protective footwear and inserts.

At Footwear Consultants we help you understand your coverage and will show you what is and isn’t covered by Medicare and/or your insurance. Here is a summary of Medicare’s Therapeutic Shoe Bill.

.

Medicare Coverage

Medicare will make a partial payment for one pair of qualified footwear per calendar year.

Requirements:

The managing Physician MUST be an M.D. or a D.O. and needs to complete the Statement of Certifying Physician for Therapeutic Footwear. The conditions requiring the shoes must include at least one of the following: History of partial or complete amputation of the foot, history of previous foot ulcerations, history of pre-ulcerative callus, peripheral neuropathy with evidence of callus formation, foot deformity or poor condition based on guidelines set by Medicare.

Congress amended Medicare statutes in may of 1993 to provide partial reimbursement for depth shoes, custom molded shoes, and shoe inserts or modifications to qualifying Medicare Part B patients with diabetes.  The Centers for Disease Control & Prevention estimates that there are 67,000 lower limb amputations due to diabetes every year.  And many experts agree that most could be prevented with the proper footwear.

Reimbursements are given within a calendar year and the qualifying patient can receive up to 80% of the allowed amount for a single pair of depth shoes and three pairs of inserts.  Or you may receive reimbursement for one pair of custom molded shoes (including inserts), and two additional pairs of inserts.

If you feel you are eligible to receive this benefit, the certifying physician must complete and sign a “Statement of Certifying Physician for Therapeutic Shoes”.

NOTE:
Medicare covers 80% and the remaining 20% can be covered by secondary insurance or is your responsibility.

Insurance Coverage

Insurance coverage for Pedorthic products and services vary. We encourage clients to contact their insurance company to determine what type of coverage is provided for prescription footwear and foot orthoses. Footwear Consultants charges for services and products that are usual and customary, but due to variations in insurance companies your out of pocket costs may vary.

Payment: We accept Visa, Mastercard, Discover, and American Express.

For additional information please feel free to contact us.