Before ordering custom orthotics, check your benefit plan and ask for a written estimate. Coverage, prescription requirements, provider qualifications and replacement limits vary. Clear information at the start can help you avoid unexpected costs.
1. Confirm your coverage before purchasing
Contact your insurer or benefits administrator rather than relying on a general description of your plan. Ask for the requirements in writing and keep a record of the response.
- Is custom-made foot orthotic coverage included in my plan?
- What percentage and maximum dollar amount are reimbursed?
- Does the limit apply per pair, per year or over another period?
- Which prescribing professionals and dispensing providers are eligible?
- Do I need a prescription, prior approval or a predetermination before ordering?
- What documents and submission deadlines apply?
The Pedorthic Association of Canada’s orthotics FAQ notes that plans differ and that patients should confirm their own coverage and referral requirements.
2. Ask what the quoted price includes
Before agreeing to an order, ask the clinic to explain the assessment, device, fitting and follow-up charges. Confirm whether adjustments, refurbishment or replacement are included, whether there is a time limit, and what additional costs may apply.
Our first pedorthist appointment guide can help you prepare. You can also read what happens during a custom orthotics fitting to understand the next stage.
3. Gather the required claim documents
Ask your insurer for its exact checklist. Depending on the plan, it may request a prescription, an itemized paid receipt, assessment information, manufacturing details and provider credentials. Confirm whether the prescription must be obtained before assessment, ordering or payment.
Check that the patient name, dates and product description are correct. Keep copies of everything you submit. Ask the clinic about direct billing and payment arrangements; do not assume that a particular insurer or program will accept direct billing.
4. Decide whether a second pair is useful
A second pair can be convenient when you regularly use different footwear, such as work boots and athletic shoes. It is not automatically necessary for every patient, and it does not guarantee better results or double the lifespan of your devices.
Bring both types of shoes to the fitting and ask whether one device can work safely in both. If separate devices are recommended, ask why and request the total cost. Our wide and extra-depth footwear guide explains why shoe volume matters.
A high dollar limit does not necessarily mean that two pairs are eligible. Check pair limits, replacement periods and medical documentation requirements before ordering. If you have a health spending account, ask the administrator whether the expense is eligible and how coordination with your main benefits works.
5. Check public-program eligibility separately
Alberta Aids to Daily Living (AADL) lists foot orthotics as excluded from its benefits. Its covered benefits include some custom-made footwear, therapeutic shoes with custom modifications and orthotic braces, subject to assessment and program rules. See the Government of Alberta’s current AADL benefits list for the distinction.
If you receive benefits through another provincial, federal or workplace program, contact that program directly. Eligibility, authorization, approved suppliers and claim procedures can differ. Do not assume that your Alberta health card or a diagnosis alone guarantees reimbursement.
6. Plan around your own deadlines
Check your plan’s benefit period, submission deadline and replacement interval. Allow time for prescriptions, appointments, manufacturing and fitting. Avoid ordering a device solely because a benefit deadline is approaching; the assessment should guide what you need.
If a claim is declined, request the reason in writing and ask the insurer what clarification or appeal process is available. Reimbursement timing depends on the insurer and the completeness of your submission.
Next steps
Review your plan, gather its requirements and contact Custom Orthopedic to ask about an assessment, pricing and supporting paperwork. Our insurance information page provides another starting point. Your insurer makes the final coverage decision.
