Questions for Your Insurance
We highly recommend you speak directly with your insurance company about the recommended brace(s). The member services' telephone number can be found on the back of your insurance card and is the best phone number to use.
When speaking with the insurance company, be sure to ask the following questions:
Are the following codes (ask your practitioner) covered by my policy?
Are there any exclusions regarding the code(s)?
Are there specific criteria that must be met to be eligible for this benefit? (Examples: age, physical therapy, specific diagnosis, etc.)
What specific benefit category does this code(s) fall under? (Examples: durable medical equipment, orthotics, prosthetics, etc.)
Are there limitations or exclusions to this specific benefit category?
Does the benefit category have a year or lifetime dollar maximum?
Is a Prior Authorization, medical review, or pre-notification required for this code(s)?
Are there specific requirements due to the cost?
Insurance Considerations
We will do an insurance verification to determine your coverage.
Your insurance may require a Prior Authorization (PA) before we can start fabrication. After completing the PA, we will contact you to confirm or modify your fitting appointment.
Payment of any out-of-pocket expenses will be required before we can release the brace to you.
"L" Codes
Insurance companies identify the type of brace using "codes." These codes describe the attributes of the different types of braces that they cover. The codes used for lower limb braces all begin with the letter "L," hence they are commonly referred to as "L" codes. It is important you understand what L-codes apply to your brace.