Does Insurance Cover Custom Orthotics in BC?

One of the first questions people ask before booking is whether custom orthotics are actually covered by insurance, and it's a fair one, because they're a meaningful investment. The good news for British Columbians: most extended health plans do cover custom orthotics. The details, how much, what's required, and how you get paid back, are where people get confused, so let's lay it out clearly.

A quick but important note up front: every plan is different. The figures below are the typical pattern in BC, but the only way to know your exact coverage is to check your own policy. I'll show you precisely what to ask.

What BC Extended Health Plans Typically Cover

Most extended health (employer or private) plans in BC cover custom-made orthotics under a footwear or medical-devices benefit. The common range is $200 to $500 per benefit year, sometimes higher. Some plans cover a set dollar amount, others a percentage of the cost up to a cap, and many limit you to one pair per year or every two years. Custom orthotics are eligible because they're a prescribed medical device; off-the-shelf drugstore insoles are not.

Note that BC's public plan (MSP) does not cover orthotics, this is strictly extended health / private insurance territory. If you don't have extended health benefits, orthotics are an out-of-pocket purchase.

What Insurers Require

To reimburse a custom orthotic claim, insurers almost always require two things:

• A biomechanical assessment performed by a regulated health professional, documenting why the orthotics are medically warranted.
• A written prescription for the custom device from that professional.

Some plans add requirements, a physician's referral, a breakdown of the lab/fabrication cost, or specific wording confirming the orthotics are custom-made from a 3D scan or cast rather than prefabricated. A chiropractor is a recognized prescribing professional for orthotics under most BC plans. At Shift, the orthotics assessment is built to produce exactly this documentation.

The Paperwork We Email You

Shift Clinic doesn't direct-bill for orthotics, but we make the claim effortless by handling all the paperwork. After your appointment, Dr. Lee emails you:

• Your biomechanical assessment report
• Your gait analysis findings
• Your written prescription
• An itemized receipt

You forward that package to your insurer's app or portal, and you're done, usually in a few minutes.

How Reimbursement Works

Because there's no direct billing, you pay for the orthotics, then submit your claim and get reimbursed by your insurer. Most reimbursements land within two to five business days of submitting. Keep a copy of everything, and if your plan covers a percentage rather than the full amount, expect to cover the difference yourself.

Do You Need a Doctor's Referral?

For the assessment and fitting itself, usually not, you can book directly. But some insurance plans require a physician's referral as a condition of reimbursement. This is the single most common reason a claim gets held up. Before you book, check your plan wording (or call your insurer) and ask the questions below. If a referral is required, get it first so everything lines up.

Three questions to ask your insurer

1. "Do I have coverage for custom-made orthotics, and what's my maximum per year?"
2. "Do you require a physician's referral in addition to the prescription?"
3. "Do you need any specific wording about the casting or scanning method?"

Frequently Asked Questions