Orthotic Predetermination

If you would like to confirm your insurance coverage before making a purchase, complete the predetermination form provided below and submit it to your insurance provider.

If your coverage is approved, keep the completed predetermination form for your records. Once your orthotics have been produced and shipped, we will provide you with a receipt and proof-of-manufacture form to submit to your insurance provider for reimbursement.

Predetermination Process:

• Download our easy to use predetermination template here.
• Complete it digitally or print it out and complete it manually.
• Send it to your insurance provider.