Orthotic Funding

How Much Do Orthotics Cost? Is There Funding Available?

 

Any customized device is expensive, and orthotics are no exception.
  • SMO: A basic pair of SMO’s can cost between $1,200–$1,500.
  • AFO: Cost of one AFO will range from $780 for a rigid type to $965 for a hinged AFO. A pair of AFO’s will range from $1,554 (rigid) to $1,930 (hinged).

 

Government Funding

Fortunately in Ontario there is a government program, called the Assistive Devices Program, which will fund 75% of some orthotics (per year).

In order to qualify for this funding, a special ADP application form must be completed by an authorizing therapist and/or signed by a physician.

The completed form must be provided to the orthotist on the day of you initial consult.

 

What about the remaining 25% balance?

The Family is responsible for paying the remaining 25% either out of pocket, or through extended health benefits or social assistance.

  • Extended Health Benefits: In most Extended Health Benefit Plans, custom orthotics are covered under the category of ‘Durable Medical Equipment, Braces, Artificial Limbs’ or under the section that covers prosthesis. Custom orthotics are more extensive that a basic orthotic that can be picked up off the shelf (which often are not covered). So be sure that the insurance provider knows that what has been prescribed is not a basic orthotic; they need to understand that this is different from a regular shoe orthotic or insert.
  • Social Assistance: If you qualify, ACSD will fund the remaining 25% that ADP does not cover. You will need to bring your most recent ACSD stub (the monthly receipt that gets mailed to you) to your orthotics appointment so that billing can be arranged.

Wearing the Orthotic

Information about wear and care of the orthotics will be provided. Orthotics are to be inserted in a shoe; children should not stand in an orthotic without a shoe on! Orthotics add bulk to the foot, and the initial pair will be slightly longer than the foot to accommodate room for a year’s growth, therefore your child will need a pair of shoes that are a size bigger than he/she would typically wear. It is often good to wait to buy a shoe until after you have received the orthotics.

 

Summary of What I need to Take to the Orthotics Appointment:

  • ADP form – completed and signed
  • Health card
  • ACSD number if you receive social assistance (the orthotist might ask to photocopy the last stub that you received in the mail so that they can send a bill and receive payment from ACSD) or
  • Self Paying out of pocket – check if they accept cash, cheque or credit card to pay the 25% balance not covered by ADP