Blue Cross Blue Shield Coverage for Multiple Orthotic Pairs

We have noticed an increase in complaints regarding second pairs of orthotics being denied after verification of benefits revealed no limits or maximums for coverage. BCBS has informed us that more of their “home plans,” that is plans funded by unions, employers, or other groups that use BCBS only for claims processing, have set limits on orthotic coverage. Furthermore, most Blue Choice plans only cover one pair per year.

When verifying benefits prior to molding and ordering orthotics, make sure to specifically ask how many pairs are covered in one calendar year. As always, record the name of the BCBS representative you spoke with, the date, and a reference number for the phone call. If checking benefits online, input both codes L3000 RT and L3000 LT twice.

BCBS policy is that they will pay for a service, even in the plan does not cover it, if it can be shown that one of their representatives misquoted benefits. Accordingly, we appeal any second pair denials we receive, but we do require the verification information mentioned above.