Plaster casting vs. 3D non-weight bearing laser scanning
For those that have studied lower limb biomechanics, there is agreement of the superiority of a non-weight bearing subtalar neutral plaster cast. In terms of having prescription orthotic devices fabricated, this technique has been the gold standard for many years.
Computerized pressure pads capture the foot in a weight bearing/deviated position and not a corrected position. By taking a plaster cast with the subtalar joint neutral and the midtarsal joint locked, the practitioner captures the ideal stable position. This position is where we want the foot to be during the weight bearing phases of the gait cycle.
For over ten years now, non-weight bearing laser scanners have been able to capture a three-dimensional virtual cast of the foot. The image accuracy is comparable to a proper non-weight bearing plaster cast. The obvious advantage to the practitioner is that there is no need for messy plaster casting. Another advantage is not having to ship casts off to the laboratory. It is quick, easy, and effective. The learning curve is small and the practitioner does not have to be extremely tech savvy to adopt this new technology.
The Canadian Life and Health Insurance Association have been consulting with podiatrists to address issues of abuse and over-utilization with respect to orthotic devices. Claims were escalating from retail vendors who were dispensing off-the-shell arch supports, calling them “orthotics” and billing $500+. Needless to say, many of these devices failed their patients. Subsequently, there would be repeat claims for orthotics, and insurers were having rapidly increasing claims experience. Our industry resolved that in order for proper orthotic devices to be made, there should be a proper protocol involved. A non-weight bearing neutral position plaster cast would be preferred. Furthermore, a biomechanical examination and prescription would be part of the process, and a proper orthotic laboratory would be required.
These requirements would ensure that proper orthotic devices would be prescribed and fabricated according to acceptable standards in the orthotics industry. Today insurers usually require a copy of a biomechanical exam and perhaps a copy of the laboratory Rx. This would show that a proper process was being carried out. While this is somewhat of an inconvenience, it shows the insurer that patients are being treated properly. At the same time, this process would steer patients toward a foot specialist rather than a retailer.
About ten years ago insurance companies were asking what the future holds in terms of orthotic fabrication. They were aware than non-weight bearing 3D laser scanners were being introduced to replace the previously preferred plaster casting technique. In the past several years the laser scanner technology has been completely accepted by the insurance industry as an equivalent alternative to the plaster casting technique.
There should be no reason for an insurance company to refuse an orthotics claim based on a non-weight bearing 3D laser scanner. In my office I have been using a laser scanner for about ten years and we haven’t had any issues. As for reimbursement for the claims, there are many different types of coverage. Even within the same insurance company there may be dozens of different plans offering carrying varying degrees of orthotics coverage.
Laboratory fees have been increasing for labour and materials, yet the insurance industry hasn’t been keeping up with increasing costs. The current customary fees for orthotics are upwards of $600+. Yet insurers’ coverage seems to be stagnating around levels from a decade ago. Nonetheless, many orthotics are medically necessary and are going to improve a patient’s mobility and comfort dramatically. In these cases the patient needs to have them, just as with eyeglasses. The patient may have to pay part of the cost if their insurance doesn’t provide 100% coverage. This is frequently the case.
An insurance company should not refuse an orthotics claim from a practitioner who provides the gold standard of care. This may be traditional casting or a non-weight bearing 3D laser scanner or equivalent technology.
Paragon will work with you to help with this process. We can provide additional documents and necessary information as required to ensure your patients are covered.