Your orthotics covered — RAMQ, CNESST, SAAQ and more
In Quebec, several government programs and insurance plans cover foot orthotics and orthopedic devices. At Marchildon, we support you every step of the reimbursement process so you can focus on your recovery.
RAMQ — Régie de l'assurance maladie du Québec
The Régie de l'assurance maladie du Québec (RAMQ) covers certain orthopedic devices and compression garments for eligible persons. However, it does not cover custom foot orthotics.
How to apply?
To benefit from RAMQ coverage, come to our clinic with your valid health insurance card and a recent medical prescription. Our team will verify your eligibility and bill RAMQ directly. No out-of-pocket cost is required for covered devices.
Compression garments
Compression garments are covered for people with lymphedema, regardless of age, on medical prescription. The annual coverage includes: 3 day garments, 1 night garment, 1 non-elastic garment or bandage, and 1 accessory. Our team guides you through all administrative procedures.
Orthopedic devices
Certain orthopedic devices are covered under certain conditions, always on medical prescription and with a daily-wear requirement for specified periods.
CNESST — Workplace Accidents
The Commission des normes, de l'équité, de la santé et de la sécurité du travail (CNESST) covers orthotics and orthopedic devices needed following a workplace accident or occupational disease. Coverage is generally 100% when the link to the accident is established.
Procedure for obtaining orthotics through CNESST
- Obtain a prescription from your treating physician indicating the link between your condition and your workplace accident.
- Provide us with your CNESST file number when booking your appointment.
- We request prior authorization from CNESST for the proposed treatment.
- Once authorization is received, we proceed with the assessment, manufacturing and delivery of your orthotics.
- The invoice is sent directly to CNESST, no charge to you.
Our team has over 60 years of experience with CNESST and thoroughly understands the administrative requirements. We handle all the paperwork so your recovery is as simple as possible. CNESST also covers compression garments, under certain conditions.
SAAQ — Road Accidents
The Société de l'assurance automobile du Québec (SAAQ) covers orthopedic devices prescribed following a road accident. Whether you are a driver, passenger, pedestrian or cyclist involved in an accident, you can benefit from this coverage for your foot orthotics, knee braces and other necessary devices.
SAAQ procedure
- See your doctor to obtain a prescription mentioning the link to your road accident.
- Provide us with your SAAQ file number and prescription.
- We submit the authorization request to SAAQ on your behalf.
- After approval, we proceed with the manufacturing and fitting of your orthotics.
SAAQ reimbursement generally covers the full cost of prescribed orthopedic devices. Our team handles all administrative procedures. SAAQ also covers compression garments, under certain conditions.
MESS — Social Assistance and Social Solidarity
The Ministère de l'Emploi et de la Solidarité sociale (MESS) provides coverage for foot orthotics to social assistance and Social Solidarity Program recipients. Beneficiaries of these programs are automatically eligible through RAMQ, which administers orthopedic device coverage for these clienteles.
To be eligible, you must be an active social assistance or social solidarity recipient and hold a valid RAMQ card. Come with your medical prescription and card; our team takes care of the rest. MESS also covers compression garments, under certain conditions.
Veterans Affairs Canada
Veterans Affairs Canada (VAC) offers health care benefits to veterans, including coverage for foot orthotics and other orthopedic devices. Eligible veterans can obtain fully covered custom orthotics through VAC.
To apply, you must have a VAC health services card and a medical prescription. We are an authorized Veterans Affairs Canada supplier and can bill the agency directly. Contact us to learn more about the process. Veterans Affairs Canada also covers compression garments, under certain conditions.
NIHB — Non-Insured Health Benefits (Indigenous)
The Non-Insured Health Benefits (NIHB) program of Indigenous Services Canada covers foot orthotics and orthopedic devices for registered First Nations members. This program complements provincial plans by covering services not offered by RAMQ.
To be eligible, you must hold a valid Indian Registry number or be a recognized Inuit. Present your status card and medical prescription at your appointment. We bill the NIHB program directly. The NIHB program also covers compression garments, under certain conditions.
Private Insurance
Most group and individual insurance plans in Quebec cover foot orthotics and other prescribed orthopedic devices. The reimbursed amount varies by contract, but generally ranges from 80% to 100% of the cost, up to an annual or biannual maximum.
How to submit a claim
- Keep your medical prescription and the detailed receipt we provide after your appointment.
- Submit your claim through your insurer's online portal, mobile app or by mail, attaching your receipt and prescription.
- The receipt we provide includes all required information: supplier code, device type, diagnosis and detailed cost.
- Reimbursement is generally processed within 2 to 4 weeks depending on your insurer.
If you are unsure about your coverage, call your insurer before your appointment to confirm eligible amounts. Our team can also help verify your eligibility.
Frequently asked questions about reimbursements
What devices are covered by RAMQ?
RAMQ does not cover custom foot orthotics. It does, however, cover compression garments for people with lymphedema, regardless of age, as well as certain orthopedic devices (knee orthosis, foot-drop lifter, finger-hand orthosis and more), under certain conditions. A medical prescription is required and our team guides you through all the procedures.
What documents do I need for CNESST reimbursement?
For CNESST reimbursement, you need an active CNESST file number, a medical prescription stating that the orthotic is related to your workplace accident, and CNESST authorization for orthotic treatment. Our team obtains the required authorization for you. It is up to you to provide us with the required medical documents.
Does SAAQ cover foot orthotics?
Yes, SAAQ covers foot orthotics and other orthopedic devices when prescribed following a road accident. You need a SAAQ file number, a medical prescription and prior SAAQ authorization.
Do private insurance plans reimburse orthotics?
Most private insurance plans cover foot orthotics and other orthopedic devices. The reimbursed amount varies by plan. We provide a detailed receipt that you can submit to your insurer. Check with your insurance company for eligible amounts and authorized replacement frequency.
Do I need to pay upfront and get reimbursed later?
For RAMQ, CNESST, SAAQ, MESS, Veterans Affairs and NIHB, we bill the paying agency directly, meaning you have nothing to pay, apart from any excess when applicable. For private insurance, you need to pay at the time of service and then submit your receipt to your insurer for reimbursement.
How often can I replace my orthotics?
Replacement frequency varies by program, device type and your needs. Private insurance plans have their own policies, often one replacement per year or every two years.
Can my children get covered orthotics?
Children benefit from the same coverage as adults, sometimes even more generous in quantity. The requirements are also the same, that is, at minimum, a prescription. Growing children may benefit from more frequent replacements depending on the program.
What if my reimbursement claim is denied?
If your claim is denied, our team can help you understand the reasons and prepare an appeal if necessary. In some cases, it is simply a matter of providing additional documentation from your doctor or clarifying the link between your condition and the orthotic need.
Need help with your reimbursement?
Our team supports you through all administrative procedures. Book an appointment and we will verify your eligibility on the spot.
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