Orthotic Solutions, Inc. is responsible for obtaining physician orders and all necessary paperwork AND does all of the billing to insurance companies. If OSI experiences any difficulties in obtaining the necessary paperwork, the patient or family member may have to assist us in the process.
Orthotic Solutions, Inc. is a provider for the following insurances:
• Medicare Part B
• Mass Health (diabetic shoes only)
• Blue Cross/Blue Shield
• Harvard Community Health Plan
• Senior Whole Health
• Commonwealth Care Alliance
• Neighborhood Health Plan
• Fallon Community Healthcare
• Network Health Plan
• Boston Medical Center HealthNet
Medicare Part B and some plans cover 80%
Most people have a secondary insurance to cover the 20% co-payment.
Senior Whole Health, HPHC, Fallon, CCA and most BC/BS plans cover 100%.
Medicare, Mass Health and most insurances will cover one pair of diabetic shoes and 3 pairs of either pre-fab or custom inserts each year.
You MUST have diabetes and one or more foot conditions, such as thickened and hard to trim toenails, ingrown toenail/s, corn, callus, bunion, deformed or hammered toe. Other issues include peripheral neuropathy with callus formation, any amputation or any history of or current ulcer.
Diabetes and one of these conditions must be in your medical record.
We will work closely with your Podiatrist and/or the MD managing your diabetes (PCP or Endocrinologist) to obtain everything we need to get your shoes covered.
Medicare and most insurances start a new year January 1st. So if you were to get shoes, for example, March 17, 2020, you could get a new pair after 1/1/21.
Some insurances, including BC/BS and Mass Health, run date to date. So if your first pair was issued 3/17/20, you would not be able to get another pair until after 3/17/21.
OSI will always check your eligibility before issuing new shoes.
Unfortunately, if all you have is straight Mass Health, orthotics and braces would not be covered.
We do, however, accept all secondary MH plans such as Fallon, Tufts, etc.
Medicare and all other insurances that we accept will cover braces for the back and knee.
If you have had a similar brace billed to your current insurance in the past, there is a waiting period which needs to be met before receiving a new one.
For back braces, it is 5 years.
For knee braces, it is between 2-3 years, depending on the brace.
Documentation must be in your medical record within the previous 12 months describing why you would benefit from either a back or knee brace.
If you are in pain, we want to help you! But you may need to make an appointment with your PCP or Ortho to get your pain…and the reason for it, documented before we can help you with a brace.
The Last thing we want is to provide a product and then, for whatever reason, not have it work out.
If either you or your fitter is uncertain a product will do what we want it to, we will allow a trial. Most people will know within a week if it will work or not. If successful, we will then submit it to billing. If not, your fitter will pick the item up in his/her travels.
Our office is located in Plymouth, MA; however, our seven fitters work from their homes. OSI covers the North and South Shores, Boston, Cape Cod, west to Attleboro and southeast to Swansea.
If you are not sure if you are in our coverage area, please send us a message.
Absolutely! The fitter covering your area would be more than happy to schedule an in-service with you and your staff!
Absolutely! We do shoe clinics all of the time…especially for COA’s, Assisted Living Facilities and Senior Housing. We can schedule clinics monthly, quarterly, etc.
We back up what we give our clients to the fullest. If a shoe is ill-fitting, we will work with you to make it right.
If a shoe rips or there is any defect, we will work with the manufacturer to get you a replacement. Some companies offer a 60 day warranty and others 6 months; however, we will do whatever we can to correct any defect.
You should Never wear your shoes outdoors if there is any chance you think you will need to return them. If a shoe looks worn, it cannot be returned.
We also can not return shoes without the box, so Please! Hold onto the shoe box until you are 100% certain they will not have to be returned.
If a shoe is creating problems to your foot, we will work with you to make it right.
Please call one of our patient coordinators at (774) 205-2278. They will verify all of your information is the same and send out for the necessary paperwork. Once that comes back, your fitter will reach out to you for an appointment.
Some insurances have a deductible that must be paid before all other services are covered.
If you have a secondary insurance plan, sometimes that will pay it, but not always. It is best to find out if you have a deductible and if you are responsible for paying it prior to receiving services from OSI.
Most people have a secondary insurance plan, such as Mass Health, that will cover any co-payment.
If you have a managed care plan, such as, but not limited to, BC/BS or Tufts, you may have to pay a co-payment for DME (Durable Medical Equipment). It is best to check with your insurance plan prior to receiving services from OSI.