Custom foot orthotics are a common and effective treatment for foot, knee, hip, and back pain. Given the level of assessment and manufacturing involved, the cost of custom orthotics is higher than over-the-counter alternatives.
For this reason, many patients rely on extended health insurance benefits to support coverage. One of the most common questions we hear at our Toronto foot clinic is “Are custom orthotics covered by my insurance in Ontario?”
The short answer: Yes, but it depends on your plan.
Below is a simple, step-by-step guide to help you understand coverage and check your benefits.
Before reviewing private health insurance coverage, many patients ask whether custom orthotics are covered by OHIP. Based on our experience, OHIP does not cover custom foot orthotics for the majority of patients.
Coverage typically comes from:
- Private health insurance
- Employer benefit plans
- Student or group insurance plans
Do Private Insurance Plans Cover Orthotics in Ontario?
Yes, many private insurance plans do cover custom orthotics in Toronto, but coverage varies by provider and plan.
Coverage usually depends on:
- Your insurance company
- Your specific plan
- Whether requirements are met (prescription, provider type, etc.)
Common Coverage Ranges
- $300 – $600 every 1–2 years (most common)
- Some plans cover higher or lower amounts
- Some plans require co-pay or partial reimbursement
What Is Usually Required for Insurance Coverage?
Most Ontario insurance plans require:
Invoice
A detailed invoice showing payment for the custom orthotics, including the clinic’s information, service date, and cost. This is required by insurance companies to process reimbursement.
Prescription
A prescription from a qualified healthcare professional confirming that custom orthotics are medically necessary for your condition.
Casting technique can be found on the prescription
Dispense date will be placed on the prescription
Biomechanical Analysis
A clinical assessment of how your feet move and function while standing and walking. This analysis supports the medical need for custom orthotics and is often required by insurers.
Orthotic Lab Manufacturer’s Profile
Documentation from the orthotic lab confirming that the devices are custom-made and identifying the manufacturer. Insurance providers use this to verify that the orthotics meet coverage criteria.
Step-by-Step: How to Check Your Orthotics Insurance Coverage
Step 1: Review Your Insurance Policy
Look for sections labeled:
- Custom Made Orthotics
- Medical Equipment or Medical Devices
- “Chiropody” or “Podiatry” services
Check:
- Coverage amount ($)
- Frequency (number of pairs per year or per two years)
Step 2: Call Your Insurance Provider or Check the Online Provider Portal
Ask these specific questions:
- Are custom foot orthotics covered under my plan?
- What is the maximum dollar amount?
- How often can I claim orthotics?
- What documents are required for reimbursement?
- Is pre-approval required?
Step 3: Confirm Provider Eligibility
Ask your insurer:
- Are orthotics from a chiropodist or podiatrist covered?
- Is the clinic required to be registered or licensed in Ontario?
Tip: Requesting a pre-approval letter can be an effective way to confirm your orthotics coverage in advance. Ask your chiropodist to provide a custom foot orthotics pre-approval letter during your visit, which can be submitted to your insurance provider before proceeding with the purchase.
Step 4: Ask About Direct Billing (If Available)
Some clinics allow partial or full direct billing for the visit fee. We are able to do this for most major insurance companies in Ontario.
The cost of the orthotics must usually be paid upfront by the patient, and submitted to the insurance company online or by mail as they are physical medical devices.
How Much Do Custom Orthotics Cost in Toronto?
Costs vary depending on the orthotic type and assessment involved. Make sure to clarify costs and billing procedures prior to proceeding with the purchase of orthotics to avoid paying too much out of pocket
Need Help Understanding Your Coverage?
If you’re unsure about your insurance coverage for custom orthotics, our clinic is happy to help guide you through the process and answer questions specific to your plan.
