Prescriptions · Plan rules · Receipts · Claims
Check your benefit requirements before dispensing
Custom-orthotic coverage varies by insurer, employer and public program. Ashfield Orthotics can provide clinical and claim documentation, but only the payer can confirm eligibility, limits and approval.
Call your plan before purchase
Ask six specific questions
Is the item covered?
Ask about custom-made foot orthotics—not generic insoles or orthopaedic shoes unless those are also relevant.
Who may prescribe?
Confirm whether the plan requires a physician, nurse practitioner, podiatrist or another named prescriber.
Who may dispense?
Ask whether a Certified Pedorthist (Canada) is an eligible provider under your exact contract.
What documents are required?
Common requirements include the prescription, biomechanical assessment, casting method, laboratory invoice and paid receipt.
What limit and frequency apply?
Ask for the dollar maximum, percentage, renewal interval and whether the limit is shared with shoes or other devices.
Is approval required first?
Some public or private plans require prior authorization. Do not assume a previous claim guarantees a future one.
The ordinary claim path
Assessment, decision, paperwork, dispensing
Book the assessment
You can be assessed without already having a prescription.
Confirm the recommendation
Proceed only if the clinical findings support custom orthotics and you choose them.
Complete plan requirements
Obtain the prescription or authorization before dispensing when your plan requires it.
Receive claim documents
Ashfield Orthotics provides the available clinical, manufacturing and payment documentation applicable to the claim.
Direct-billing pathways
Availability depends on identity, eligibility and authorization
Ashfield Orthotics currently identifies the following pathways as ones for which direct claim submission may be available. A program card or group membership does not, by itself, establish that a particular item will be paid.
| Program or pathway | What to bring | What still needs confirmation |
|---|---|---|
| Veterans Affairs Canada, RCMP or Canadian Armed Forces through Medavie Blue Cross | Current identification, prescription or authorization information, and any claim reference | Active eligibility, benefit code, frequency, dollar limit and preauthorization |
| Non-Insured Health Benefits (NIHB) | Status or client identification and prescriber documentation | Item eligibility, approved prescriber, prior approval and program limits |
| Saskatchewan supplementary-health pathways | Current eligibility documentation and prescription/authorization | Whether custom orthotics and this provider are approved for the individual claim |
| Saskatchewan Workers’ Compensation Board or another active case | Claim number, case-manager information and prescription/authorization | Relationship to the accepted claim and approval before service |
Before arriving: Call the clinic if you expect direct billing so the required identifiers and authorization can be checked. Never send health or benefits information through an unsecured website form.
Workplace and private plans
Most private claims remain reimbursement claims
You may need to pay the clinic and submit the receipt and supporting documents to your insurer. Coordination with a spouse’s or another plan may be possible, but each contract sets its own rules.
Ask your insurer to send its answer in writing or record the date, representative and reference number. This is useful when wording such as “reasonable and customary,” “every two years” or “eligible provider” needs interpretation.
Taxes and medical devices
Tax treatment depends on the item and documentation
Canada’s GST/HST rules zero-rate certain orthotic and orthopaedic devices when the statutory conditions are met. The clinic applies the tax treatment appropriate to the specific transaction and documentation. Tax treatment is separate from benefit-plan eligibility.
Official sources
Program rules can change
- Indigenous Services Canada: NIHB footwear and orthotics criteria
- Veterans Affairs Canada: Programs of Choice
- Medavie Blue Cross: CAF, RCMP and VAC claim access
- Canada Revenue Agency: Medical and assistive devices
Clinical need first, paperwork before dispensing