Prothetic and Orthotic Financial Considerations

The cost for a prosthesis or orthosis can vary depending upon the technology and materials used, the complexity of fabrication and the extent of follow-up care required.

To most insurance companies, prosthetics and orthotics are considered “Durable Medical Equipment Prosthetics, Orthotics & Supplies,” or DMEPOS. 

Before your first evaluation, we recommend that you call your insurance carrier to verify DMEPOS coverage and to clarify the dollar amount or percentage covered and any specific types of devices that are excluded under your insurance plan. 

Some insurance plans place limitations on coverage based upon frequency of replacement, or a lifetime maximum dollar amount. You will be responsible for full payment of all services which are not covered by your plan. To better facilitate your care, you can gather this information from your insurance carrier in advance.

As in other areas of healthcare, most insurance plans will only cover items that are medically necessary. Our staff will provide a summary of your evaluation, as well as your physician’s evaluation to assist your insurance company with reviewing your claim. Our prosthetists and orthotists will always present a recommendation for your device based upon what is medically appropriate for your condition.

After your evaluation appointment, your prosthetist or orthotist will generate a specific device recommendation which will be forwarded to your physician for approval and to our financial coordinator for verification of benefits.

Before continuing with casting, measurement or fitting of a custom device, our financial coordinator will provide a breakdown of the estimated cost for the device that has been recommended for you.  

You will have the opportunity to review this cost estimate, ask questions and decide whether to proceed. With most prostheses or orthoses, there is an opportunity to be flexible with the design to strike a balance between your medical needs and financial responsibility.

If you have any questions or concerns about our financial policies, please feel free to call us at 312-238-2810 and ask to speak with a financial coordinator. RIC also offers a variety of financial assistance programs to help bring quality care to all of our patients with prosthetic and orthotic needs.