From: Elliot Udell, DPM
It’s true that a good lab probably cannot make custom orthotics for 45 dollars. There is, however, a greater issue behind this problem. Why are so many of our colleagues attracted to labs that are charging 45 dollars for "custom" orthotics?
Several years ago, when I was casting for and dispensing a great deal of orthotics, I ordered a set of custom tennis orthotics for a patient. He agreed to pay me for them. They addressed his problem nicely and all was well until I received a call from his wife and the insurance company. They informed me that I am contractually obligated to accept only what the insurance company is willing to pay.
Bottom line: I had to refund what the patient paid me and agree to accept twenty-six dollars and fifty cents for the orthotics. I lost money, but learned that with most of my insurance carriers, I would no longer be able to cast for and dispense orthotics. I consulted with the APMA insurance expert and was bluntly told that if I opt out of the contract, I could kiss all other podiatric services goodbye. I had to make a hard choice.
Elliot Udell, DPM, Hicksville, NY
From: Timothy Messmer, DPM
I agree wholeheartedly with Jeff Root when he said, “I can assure you that it is not economically feasible for a company to make a profit and therefore stay in business selling custom orthoses for forty-five dollars a pair; and comply with the HCPCS definition of custom (i.e., an L3000 device) at the same time.”
Having been in private practice for over 27 years, and now serving as Medical Director for one of the premier custom orthotic laboratories in the world, I can say with confidence that all of us involved in the business of fabricating (truly) custom foot orthoses know what “custom” means and what it does not. Any company or vendor that is promoting what they offer/manufacture as truly custom orthoses knows what the HCPCS definition is for such a device (e.g., L3000).
Custom means the device is made from a plaster or foam or digital replica of the patient’s foot. Labs that use a library system are not creating actual patient-specific custom devices from a positive model of the specific patient’s foot. Taking a device from a library and ‘customizing’ it does not make it a truly custom orthosis either. Labs that take either of these manufacturing paths are choosing to not follow the universally-accepted definition, usually for their own economic gain and hopes of gaining market share.
Perhaps our podiatric organizations as well as publications that receive revenue from these dubious companies should have higher standards for what they will accept from vendors – rather than letting them say/sell whatever they want as long as they pay the advertising bill. We can do better as a profession and for our patients.
Timothy Messmer, DPM, Medical Director, Northwest Podiatric Laboratory
