09/19/2022    Paul Kesselman, DPM

Why Aren’t Orthotics Covered By Insurance? (V. Kathleen Satterfield, DPM

Over the past several years, there have been many
letters regarding the lack of biomechanical
leadership, fellowships and research led by
podiatrists. It is quite refreshing that there has
been an uptick in this by academia, but it still in
my opinion, falls far too short of what is needed
(at least as what I see from other professions),
but at least there are some rumblings in the
correct direction.

What continues to baffle me is the link between
biomechanical leadership/ research and orthotic
reimbursement, regardless of who is performing the
studies. Here are some questions to think about:
1) Has your reimbursement for anything gone up
since more and more providers became in network
participating providers with insurance companies?
2) Have insurance companies reimbursed in
accordance with inflationary pressures?
3) Have insurance companies always paid you for
services once you had them pre-authorized?
4) Have your reimbursements been commensurate with
your level of skill?
5) Are your reimbursements for DME and in
particular foot orthotics commensurate with the
price of the wholesale costs of providing those
goods (especially during the PHE), plus the
paperwork and professional services associated with
providing those devices?

I would dare say that most of you would be stating
the answer is no to all these questions.
And I also would suggest that none of those issues
have anything at all to do with advancement of
biomechanics by podiatrist or other professionals,
the acceptance of Root, Shavelson or any other
past, present or future theories. As others have
said and I must agree, there must be a separation
of biomechanics from orthotics.

Yes one must have a sound biomechanical approach to
diagnosing patients and understanding what is
causing their patients' pathologies. The secondary
issue is developing a sound treatment protocol.
Whether that involves orthotics or not must come
after an appropriate H/P and PE. Otherwise, we are
simply replicating the business practices of some
retail stores (as was noted by Jordan Stewart) and
that is placing a higher value on the treatment
course prior to even understanding the patient's
diagnosis.

So while all of us may agree to encourage further
podiatric leadership of research in biomechanics,
let's not fall folly to tying those advancements
tantamount to an acceptance of third party
reimbursement for orthotics. This is especially
true when some of the few carriers which do cover
orthotics, reimburse a paltry $200 for a pair of
devices.

If that is what we really are aiming for, then it
would almost be impossible to provide a high
quality custom fabricated device to patients.
Rather, we should aim for the optometry type model,
where no one argues over the medical necessity of
eyeglasses. However, if patients are covered for
eyeglasses at all, their coverage is limited only
to a certain extent. That in my opinion should be a
whole separate argument from the current issues
over biomechanical theories and the one podiatry
(and other professions) should be aiming to
eventually emulate.

Paul Kesselman, DPM, Oceanside, NY

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