Orthotic Appliances. Coverage for Orthotic Appliances is limited to custom-made leg, arm, back and neck braces, when related to a surgical procedure or when used in an attempt to avoid surgery, and is necessary to carry out normal activities of daily living excluding sports activities. Coverage includes the initial purchase, fitting or adjustment. Replacements are covered only when Medically Necessary due to a change in bodily configuration. All other Orthotic Appliances are not covered. The determination of whether a covered item will be paid under the DME, orthotics or prosthetics benefits will be based upon its classification as defined by the Centers for Medicare and Medicaid Services.
Orthotic Appliances. Corrective shoe inserts specifically designed and constructed for the employee or dependent and prescribed by a physician, chiropractor, podiatrist or chiropodist are covered at one hundred percent (100%) of the cost or repair per year to a maximum of five hundred dollars ($500) per year;
(i) Effective January 1, 2007 the Supplementary Health & Hospital Plan will be amended to include expanded coverage for Diabetic Pumps and Supplies as follows:
Orthotic Appliances. Functional foot Orthotics including those for plantar fasciitis, pes planus (flat feet), heel spurs, Orthopedic or corrective shoes, arch supports, shoe appliances, foot Orthotics, and custom fitted braces or splints are not Covered, except for patients with diabetes or other significant peripheral neuropathies. Custom-fitted Orthotics/Orthosis are not Covered except for knee-ankle-foot (KAFO) Orthosis and/or ankle-foot Orthosis (AFO) except for Members who meet national recognized guidelines. Artificial aids including speech synthesis devices are not Covered, except items identified as being Covered in the Benefits Section. Common disposable medical supplies that can be purchased over the counter such as, but not limited to, bandages, adhesive bandages, gauze (such as 4 by 4’s), and elastic wrap bandages are not Covered, except when provided in a Hospital or Practitioner’s/Provider’s office or by a home health professional. Gloves are not Covered, unless part of a wound treatment kit. Elastic Support hose are not Covered.
Orthotic Appliances. Functional foot Orthotics including those for plantar fasciitis, pes planus (flat feet), heel spurs, Orthopedic or corrective shoes, arch supports, shoe appliances, foot Orthotics, and custom fitted braces or splints are not Covered, except for patients with diabetes or other significant peripheral neuropathies. Custom-fitted Orthotics/Orthosis are not Covered except for knee-ankle-foot (KAFO) Orthosis and/or ankle-foot Orthosis (AFO) except for Members who meet national recognized guidelines. Artificial aids including speech synthesis devices are not Covered, except items identified as being Covered in the Benefits Section.
Orthotic Appliances. Orthotic devices or appliances means any rigid or semi-rigid device needed to support a weak or deformed body part or to restrict or eliminate body movement. Coverage for orthotic appliances is limited to custom-made leg, arm, back, and neck braces when related to a surgical procedure or when used in an attempt to avoid surgery and is necessary to carry out normal activities of daily living, excluding sports activities. Coverage includes the initial purchase, fitting, or adjustment. Replacements are covered only when Medically Necessary due to a change in bodily configuration. All other orthotic appliances are not covered. The determination of whether a covered item will be paid under the DME, orthotics or prosthetics benefits will be based upon its classification as defined by the Centers for Medicare and Medicaid Services.
Orthotic Appliances. Orthotic Appliances include braces and other external devices used to correct a body function including clubfoot deformity. Orthotic Appliances must be Medically Necessary and may require Prior Authorization. Orthotic Appliances are subject to the following limitations: • Foot Orthotics or shoe appliances are not Covered, except for our Members with diabetic neuropathy or other significant neuropathy. • Pre-fabricated knee-ankle-foot orthoses (KAFO) and ankle-foot orthoses (AFO) are Covered for our Members in accordance with nationally recognized guidelines. • Covered Orthotic Appliances including: o Podiatric appliances for prevention of feet complications associated with diabetes. o Repair and replacement of durable medical equipment, prosthetics and orthotic devices must comport with state law. Please see Diabetes Section.
Orthotic Appliances. Orthotic Appliances include braces and other external devices used to correct a body function. Orthotic Appliances must be Medically Necessary and may require Prior Authorization. Orthotic Appliances are subject to the following limitations: • Foot Orthotics or shoe appliances are not Covered, except for our Members with diabetic neuropathy or other significant neuropathy. • Pre-fabricated knee-ankle-foot orthoses (KAFO) and ankle-foot orthoses (AFO) are Covered for our Members in accordance with nationally recognized guidelines. • Covered Orthotic Appliances including: o Podiatric Appliances for prevention of feet complications associated with diabetes o Repair and replacement of durable medical equipment, prosthetics and orthotic devices must comport with state law. Please see the Diabetes section. Standard Prosthetic Devices are artificial devices, which replace or augment a missing or impaired part of the body. The purchase, fitting and necessary adjustments of Prosthetic Devices and supplies that replace all or part of the function of a permanently inoperative or malfunctioning body part are Covered when they replace a limb or other part of the body, after accidental or surgical removal, congenital conditions and/or when the body’s growth necessitates replacement. Prosthetic Devices must be Medically Necessary and may require Prior Authorization. Examples of Prosthetic Devices include, but are not limited to: • breast prostheses when required because of mastectomy and prophylactic mastectomy • artificial limbs • prosthetic eye • prosthodontic appliances • penile prosthesis • joint replacements • heart pacemakers • tracheostomy tubes and cochlear implants
Orthotic Appliances. Orthotic Appliances include braces and other external devices used to correct a body function. Orthotic Appliances must be Medically Necessary and may require Prior Authorization. Orthotic Appliances are subject to the following limitations: • Foot Orthotics or shoe appliances are not Covered, except for our Members with diabetic neuropathy or other significant neuropathy. • Pre-fabricated knee-ankle-foot orthoses (KAFO) and ankle-foot orthoses (AFO) are Covered for our Members in accordance with nationally recognized guidelines. • Covered Orthotic Appliances including: o Podiatric appliances for prevention of feet complications associated with diabetes. Prosthetic Devices are artificial devices, which replace or augment a missing or impaired part of the body. The purchase, fitting and necessary adjustments of Prosthetic Devices and supplies that replace all or part of the function of a permanently inoperative or malfunctioning body part are Covered when they replace a limb or other part of the body, after accidental or surgical removal and/or when the body’s growth necessitates replacement. Prosthetic Devices must be Medically Necessary and may require Prior Authorization. • breast prostheses when required because of mastectomy and prophylactic mastectomy • artificial limbs • prosthetic eye • prosthodontic appliances • penile prosthesis • joint replacements • heart pacemakers • tracheostomy tubes and cochlear implants
Orthotic Appliances. Orthotic Appliances include braces and other external devices used to correct a body function including clubfoot deformity. Orthotic Appliances must be Medically Necessary and require Prior Authorization. Orthotic Appliances are subject to the following limitations: • Foot Orthotics or shoe appliances are not Covered, except for our Members with diabetic neuropathy or other significant neuropathy. • Custom fabricated knee-ankle-foot orthoses (KAFO) and ankle-foot orthoses (AFO) are Covered for our Members in accordance with nationally recognized guidelines. Prosthetic Devices are artificial devices, which replace or augment a missing or impaired part of the body. The purchase, fitting and necessary adjustments of Prosthetic Devices and supplies that replace all or part of the function of a permanently inoperative or malfunctioning body part are Covered when they replace a limb or other part of the body, after accidental or surgical removal and/or when the body’s growth necessitates replacement. Prosthetic Devices must be Medically Necessary and require Prior Authorization. Examples of Prosthetic Devices include, but are not limited to: • breast prostheses when required because of mastectomy and prophylactic mastectomy • artificial limbs • prosthetic eye • prosthodontic appliances • penile prosthesis • joint replacements • heart pacemakers • tracheostomy tubes and cochlear implants
Orthotic Appliances. Orthotic Appliances include braces and other external devices used to correct a body function. Orthotic Appliances must be Medically Necessary and may require Prior Authorization. Orthotic Appliances are subject to the following limitations: • Foot Orthotics or shoe appliances are not Covered, except for our Members with diabetic neuropathy or other significant neuropathy. • Custom fabricated knee-ankle-foot orthoses (KAFO) and ankle-foot orthoses (AFO) are Covered for our Members in accordance with nationally recognized guidelines. • Covered Orthotic Appliances including: o Podiatric appliances for prevention of feet complications associated with diabetes. o Repair and replacement of durable medical equipment, prosthetics and orthotic devices must comport with state law. Please see the Diabetes Section.
