RAMQ and foot orthotics: who is covered?

The cost of custom foot orthotics is a legitimate concern for many patients. Fortunately, the RAMQ foot orthotic reimbursement program allows several categories of Quebecers to obtain partial or full coverage. This article clarifies the eligibility criteria and the steps required to benefit from reimbursement.

Who is eligible for RAMQ reimbursement?

The RAMQ foot orthotic reimbursement program covers several groups of people. Children under eighteen who are registered with Québec’s public health insurance plan are eligible. People aged sixty-five and over with RAMQ coverage are also eligible. Recipients of social assistance and social solidarity benefits can also obtain reimbursement. Finally, people covered by the CNESST for a workplace accident or by the SAAQ for a road accident benefit from separate but complementary coverage.

Required documents

To obtain RAMQ reimbursement for a foot orthotic, a medical prescription is mandatory. This prescription must come from a physician, a podiatrist or a specialist and must state the need for custom foot orthotics. You must also present your valid health insurance card at your visit. In some cases, a specific RAMQ form must be completed by the prescribing professional. Your orthotist will guide you in obtaining all the necessary documents.

Covered amounts

The amount of RAMQ foot orthotic reimbursement coverage varies according to the patient’s category and the type of orthotic prescribed. The RAMQ sets a maximum rate for foot orthotics, and the patient may have a contribution to pay if the cost of the orthotic exceeds that rate. For children and seniors, the contribution is generally minimal. Social assistance recipients may benefit from full coverage. It is important to note that replacement frequency is also regulated, generally one pair every two years for adults and annually for growing children.

Private insurance

In addition to the RAMQ program, most group and individual insurance plans offer coverage for custom foot orthotics. Amounts vary considerably from one plan to another, ranging from a few hundred dollars to full coverage. We recommend checking with your insurer before your first visit to learn the terms of your coverage. Some plans require pre-authorization, while others accept a direct claim with the invoice and the medical prescription.

Administrative support at Marchildon

At Marchildon, we understand that RAMQ foot orthotic reimbursement procedures can seem complex. That is why our administrative team takes care of all the formalities. We verify your eligibility, prepare the required forms and submit claims directly to the RAMQ. For private insurance, we provide all the documents needed to make your reimbursement easier. Our goal is to let you focus on your health without worrying about paperwork.