How often do patients ask you or your office staff “How much do you charge for foot orthotics?”
The answer for most podiatric offices will range from $400 to $600, and will often come as a shock to the naïve patient. After all, how could two pieces of plastic cost that much money?
The answer to this question unveils many myths and misconceptions about foot orthotic therapy that exist among podiatric physicians and their patients.
The first problem arises with the perception that the “cost” of foot orthotic therapy is really just the cost of the pair of foot orthoses. When dispensing a durable medical device, practitioners commonly purchase the device from a vendor, such as a custom foot orthotics laboratory, and then turn around and resell this device to the patient. The “markup” or margin on this sale should run about 100 percent of the invoice cost of the device although many durable medical equipment devices are reimbursed by insurance payors at a rate far higher than this amount. Either way, any retailer in any other business would love to enjoy a “keystone” margin of profit on the sale of any item.
Therefore, the average cost, to the doctor, of a pair of functional foot orthoses in the United States is about $90. Thus, the cost to the patient should be around $200 and at most $300. Yet most podiatric physicians would never consider “discounting” their orthotic price to the patient for this seemingly low price.
Why? Most podiatric physicians recognize that their orthotic “fees” actually represent a group of charges for the entire orthotic treatment program. Quality foot orthotic therapy requires a detailed biomechanical exam, gait analysis and casting for the devices. Yet most insurance companies will not reimburse for these services even though they are critical to the success of treatment.
Therefore, I recommend that podiatric physicians never quote a fee for “orthotics” but rather quote a fee for an “orthotic treatment program,” which includes the office visit, biomechanical exam, gait analysis, negative impression casting and a fee for the orthotic devices.
Yes, most insurance payors will only reimburse for the orthotic devices and the fee will many times more than double the laboratory invoice. Either way, the non-covered services beyond the cost of the orthotic devices should be a patient obligation as long as the fee estimate and notification of non-covered benefits are provided to the patient in advance.