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, and that is the single most common reason a claim gets held up. It is worth a look at your plan wording at some point before your orthotics are made, so that if a referral is required you have time to get one. The questions below are the useful ones to put to your insurer.
Three questions to ask your insurer
- "Do I have coverage for custom-made orthotics, and what's my maximum per year?"
- "Do you require a physician's referral in addition to the prescription?"
- "Do you need any specific wording about the casting or scanning method?"
Frequently Asked Questions
Does extended health insurance cover custom orthotics in BC?
Most plans do, typically $200 to $500 per benefit year, with a prescription and biomechanical assessment from a regulated health professional. Amounts and conditions vary by plan, and some insurers also require a physician's referral, so it is worth knowing what your own plan asks for.
Do I need a doctor's referral for custom orthotics in BC?
Usually no referral is needed to be assessed and fitted, but some plans require a physician's referral for reimbursement. Check your plan's wording, and if yours requires one, get it before your assessment.
Can Shift Clinic direct-bill my insurance for orthotics?
We don't direct-bill, but we handle the paperwork. Dr. Lee emails your assessment report, gait findings, prescription, and receipt right after your appointment, so you can submit in minutes. Most reimbursements arrive within two to five business days.
Why would an orthotics claim get denied?
Most often a missing physician referral where the plan required one, a receipt without enough detail, claiming inside a renewal window, or a plan that reimburses only certain provider types. Almost all of it is avoidable if the documentation is written correctly the first time.
Can I use a Health Spending Account for custom orthotics?
Usually yes, and often with fewer conditions than a traditional extended health plan. The normal sequence is to claim against your extended health plan first and submit the remainder to the HSA, since claiming the other way round can forfeit coverage you were entitled to. Confirm the order your provider expects.
Why Claims Get Denied, and How to Avoid It
Most denied orthotics claims come down to a handful of predictable causes rather than the insurer being difficult.
A missing physician referral. The most common one. Some plans accept a chiropractor's prescription on its own; others require a doctor's referral as a separate condition of reimbursement. The prescription being valid clinically does not make it sufficient contractually.
A receipt without enough detail. A total with no breakdown is easy to reject. Insurers generally want the device described, the casting or scanning method named, and the assessment identified as a separate line.
Claiming inside the renewal window. If your plan covers one pair every two or three years and you claimed within that period, the claim fails regardless of medical need.
Provider type restrictions. A minority of plans reimburse only devices dispensed by specific professions.
Nothing here is exotic, and most of it is avoidable if the documentation is written correctly the first time. Mention anything you already know about your plan at your orthotics assessment and Dr. Lee will write it that way rather than issuing a generic receipt.
Using a Health Spending Account
If your benefits include a Health Spending Account alongside your regular plan, it is worth knowing how the two interact.
An HSA is typically a fixed annual pot you can spend on eligible health expenses with far fewer conditions than a traditional plan — often no referral requirement and no provider-type restriction. In many cases it can also absorb the portion your extended health plan did not cover.
The usual sequence is to claim against the extended health plan first, then submit whatever remains against the HSA. Submitting to the HSA first sometimes forfeits coverage you were entitled to under the main plan. If you have both, check the order your provider expects.
Ready to use your benefits?
Book a biomechanical assessment in Downtown Vancouver. We email all the paperwork your insurer needs.
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