Custom orthotics are often claimable in Ontario, but not through OHIP, and not automatically. Most extended health plans pay part of the cost when three conditions are met. Here is what they are, what OHIP and government programs do and do not pay, and what to have ready before you book.
Does OHIP cover orthotics?
No. OHIP does not pay for custom foot orthotics. Ontario’s Assistive Devices Program pays toward some custom braces for the arm, leg and spine, but it specifically leaves out foot orthoses that support under the foot up to the ankle, and shoes. So for most people in Ontario, the route is an extended health plan through work, a spouse’s work, a union, a school or a private policy.
What extended health plans usually ask for
A prescription with a diagnosis
Most plans want a prescription from a physician, chiropodist or podiatrist that names a medical diagnosis. Green Shield also accepts a nurse practitioner. A prescription that lists only symptoms, such as foot pain, may be refused, so ask your prescriber to include the diagnosis. The federal public service plan (PSHCP), for example, treats a prescription as valid for three years; other plans set their own rules.
A dispenser your plan accepts
Plans keep a list of who may dispense orthotics. Green Shield’s list includes podiatrists, chiropodists, pedorthists and orthotists. Other plans have similar lists. At Pro Motion Healthcare in Barrie, orthotics are assessed and dispensed by a certified pedorthist (C.PED).
The right measurements and receipts
Insurers look for a proper assessment (a biomechanical exam or gait analysis), a 3D cast or scan of the foot, an itemised receipt showing the pickup date and payment in full, and often a detailed lab invoice. Orthotics made from a simple footprint or pressure plate alone, and off-the-shelf insoles, are generally not eligible.
How much plans pay
It varies a great deal. As one published example, PSHCP pays for one pair per person per calendar year, up to a reasonable and customary amount of $550, reimbursed at 80 percent. Many other plans allow one pair every one to three years, with a dollar cap. Your benefits booklet or your insurer’s app will have the figures for your plan.
| Question for your insurer | Why it matters |
|---|---|
| Are custom orthotics covered, and how much per pair? | Sets what you pay yourself |
| How often can I claim a new pair? | One a year, or one every two or three |
| Who must write the prescription? | Physician, chiropodist, podiatrist or nurse practitioner |
| Which providers may dispense them? | A pedorthist is accepted by plans such as Green Shield |
| Do you take direct billing, or do I claim myself? | Decides what you pay at pickup |
Be wary of offers built around your plan
Insurers investigate clinics that bill for orthotics nobody needed, and delist some of them. Green Shield warns members to avoid two-for-one deals, gifts that come with orthotics, mass screenings and family-wide offers. A claim tied to one of those can be refused, or audited later.
WSIB, ODSP, Veterans Affairs and auto insurance
Other funding may apply case by case. Pro Motion Healthcare says it directly bills WSIB, ODSP and Veterans Affairs, and has a coordinator for motor vehicle accident claims who works with auto insurers.
- WSIB: orthotics may be covered for a work injury if they are medically necessary and prescribed by a regulated health professional.
- ODSP: needs a prescription from your family doctor or specialist. The clinic prepares the quote, submits it and talks to your caseworker; it says approval typically takes 2 to 4 weeks. ODSP pays only when no other source does.
- Auto insurance: injuries from a car accident may be funded under your auto policy; minor injuries have a capped treatment budget.
- Veterans Affairs: ask the clinic and your case manager what may be funded.
A simple order to do things in
- Call your insurer or check your booklet: coverage, frequency, who prescribes and who dispenses.
- Get a prescription with a diagnosis.
- Book the assessment and 3D scan, and bring your plan and member numbers.
- Pick up and pay; keep the itemised receipt and any lab invoice.
- Submit the claim, or let the clinic bill directly where it can.
The clinic’s price for custom orthotics is given on its site as $495 per pair at the time of writing; ask for the current price. For how the orthotics are made, see custom orthotics Barrie; for what to look for in any clinic, see how to choose the best orthotics in Barrie.
Not sure what your plan covers? Call Pro Motion Healthcare before you book.
Questions people ask
Are orthotics covered by OHIP?
No. OHIP does not cover custom foot orthotics, and the Assistive Devices Program excludes foot orthoses.
Do I need a prescription for orthotics in Ontario?
To buy them, not always. To claim them on most plans, yes: a prescription with a diagnosis from a physician, chiropodist or podiatrist, and some plans accept a nurse practitioner.
Does it matter who dispenses my orthotics?
Yes. Plans pay only when a provider on their list dispenses them, and plans such as Green Shield list pedorthists. Check your plan’s list.
Does ODSP pay for orthotics?
It can, with a prescription from your family doctor or specialist and approval from ODSP. Pro Motion Healthcare prepares the quote and works with your caseworker.