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Are shoes and inserts covered durable medical equipment? 

 

 

Insurance companies process shoes and inserts under 2 different categories: orthopedic and therapeutic.

Orthopedic Shoes are considered shoes that are Oxford, high top, depth inlay, or custom non-diabetic shoes. Insurance companies only cover these items under certain circumstances. Most insurance companies will only pay for the shoes and inserts if they are an integral part of a covered leg brace and they are medically necessary for the proper functioning of the brace. If the shoe is an integral part of a brace for one side, the matching shoe for the other side that is not attached to a brace, may be denied as a patient responsibility because it is considered a non-covered charge. Shoes and inserts will also be covered if the insurance contract has a benefit for orthotics and does not exclude foot orthotics. If the insurance policy does have the benefit for orthotics the shoes and inserts will usually be covered if they are used to treat a medical problem or deformity.

 


Therapeutic Shoes are considered extra depth shoes or custom molded shoes. Shoes and inserts are covered in select patients with diabetes for prevention or treatment of diabetic foot ulcers. Most insurance companies will cover one pair of shoes each calendar year. A statement from the physician managing the diabetic condition is usually required stating the patient has had a history of footamputation, history of previous foot ulceration, history of pre-ulcerative callus, peripheral neuropathy with evidence of callus formation, foot deformity, or poor circulation.

 

 

 

 



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