08/14/2026
Why are they not paid and why does Arches FootCare not accept insurance?
Contrary to your insurance company’s information, we have found that most times custom orthotic coverage usually has little to do with medical necessity; though some carriers are complying with state mandates for certain conditions. Which means your insurance company can agree that they are medically necessary, but still not cover them because they are a policy exclusion.
In most situations when the insurance premium is partially paid by the employer, the employees and their dependents are subject to the provisions written in their plan documents. Each employee has a right to a full length copy, usually 100-200 page plan documents that disclose the employer’s specific coverage limitations.
Many employers have excluded custom orthotics as a covered benefit, as a way to save their company the out of pocket expense of a custom item.
More recently due to a number of state mandates, employers are modifying the language of their benefits to include orthotics for certain medical conditions (example diabetic conditions or before or after surgery).
Currently Medicare interprets custom orthotics as a preventive service and therefore does not cover the custom item, unless it is an integral part of a brace. Medicare may cover diabetic shoes and inserts annually, but only if the patient meets strict requirements.
So, while your insurance may tell you they cover the custom orthotics, in most case they do not pay for them when billed by the company that made and dispensed your orthotics.
While State mandates require a Doctors Prescription is for custom Orthotics, it’s not a assurance that it is covered.
Off the shelf arch supports are never covered by insurance.
