What is a Prosthesis?
A prosthetic device (prosthesis) is an artificial replacement for a missing limb or part of a limb. A properly designed and fitted prosthesis can help you do many of the things you could do before, especially if you work with your physical therapist to learn how to use it.
What is an Orthotic Device (Orthosis)?
An orthosis is a brace or molded device used to control, limit or guide movement for a specific reason. A brace on a leg can allow the limb to heal from an injury, while a back brace can correct the curvature of scoliosis.
What is a Pedorthic Device?
Pedorthics are supportive devices specifically used to relieve pain and correct the movement of feet. For example, custom-molded orthotics placed in shoes hold the feet in a natural position to relieve the pain of a heel spur or plantar fasciitis.
Does insurance cover Orthotic and Prosthetic services?
Most health insurance policies cover Orthotic and Prosthetic services. We are in-network providers for many insurance carriers. Each insurance policy is different and coverage for orthotic and prosthetic services can vary depending on the particular device.
To find out if you are covered:
Your insurance carrier may require you a co-pay. If so, you will receive a statement from the Patient Financial Services after your insurance has been billed. You will be responsible for any unpaid balance after reimbursement by your insurance carrier.
What if I don't have any insurance?
It is important to discuss this issue in advance so appropriate arrangements can be made. Our Patient Financial Services can set up a payment plan that fits your budget. If you qualify for assistance, you can apply to the Strong Health Charity Care Program to help you with payment.
Will Medicare cover O&P services?
We do accept Medicare. However, we are not 'Medicare Providers' and do not 'accept assignment.' Some devices (or parts of devices) are covered, while others are not. Medicare funding guidelines based upon medical necessity, diagnosis, and service frequency may affect your eligibility. Our office manager can help you determine your eligibility once our practitioners have done an evaluation and determined you specific needs.
Will Medicaid cover O&P services?
We do accept Medicaid, and our office staff is very familiar with its provisions. Some devices (or parts of devices) are covered, while others are not. In addition, some devices require prior approval, which can cause a delay in delivery of your prosthesis. If this is the case with your device, we will inform you prior to providing any services.
How do I make a payment?
We accept cash, checks, Visa, Master Card, private insurance, Medicare, Medicaid and approved Workers' Compensation, and MVA.
What if I have a co-payment amount with my insurance?
You will receive a bill from the Patient Financial Services .
How much will my orthosis/prosthesis cost?
Once we have evaluated your specific needs, we can provide an estimate of the cost of your device. The coding system used for O&P billing (established by Medicare, but used by all payers) has more than 1,000 codes. Specific 'base codes' describe various orthotic/prosthetic devices in their most basic/generic form. Additional codes account for the additions that are needed to customize the device to meet the patient's unique functional needs. We need to be certain that we know all of the elements and additions you need so that we can quote you the correct price.
Our Orthotists, Prosthetists and Pedorthists provide free, no obligation consultations to help you understand the full cost of the final prosthetic or orthotic. Once we know exactly what you need, we can work with an accurate set of codes to confirm your coverage.
Do I need to make an appointment?
Yes. Making an appointment ensures that you are scheduled to see the practitioner who is best able to meet your needs. When repairs or maintenance are required, a scheduled appointment helps ensure that parts are ordered (if possible) and that one of our skilled technicians is available to perform the repair.
We provide simple off-the-shelf devices or minor adjustments to existing orthoses on a walk-in basis, but we ask that you call ahead. If we have a full patient load on the day you need your repair, you may have a significant wait.
What are your hours of operation?
Monday- Friday 8:00am to 4:30pm (other times by appointment only).
Do I need a referral to make an appointment?
A referral is not necessary. However, a doctor's prescription is required for us to provide a new device, or to make modifications or repairs to an existing one. A consultation does not require a prescription, but a prescription would be required before we could provide further services.
Do I need to bring my prescription to my appointment?
Yes, your prescription allows us to begin our work immediately. To be sure that you have your prescription from your doctor in time for your appointment in our department, ask for it at least two weeks prior to your appointment. If you are unable to obtain a prescription, we can request one for you—but if your doctor is not available, there may be a delay in your care until the prescription is received.
What if I have to cancel my appointment?
We understand that emergencies do arise and that appointments need to be cancelled. We request that you give us 24 hours' notice so that we can allow another patient to fill that time slot.
I need to have a strap/rivet/buckle replaced. Do I need an appointment?
We can often make minor repairs without an appointment. If it turns out that your device requires further adjustment or major repairs, you will need to schedule an appointment with a practitioner to ensure that all of your needs are met.
What do I need to bring with me to my first visit?
Please bring your prescription, your insurance card and any other related billing information.
We have gowns available for the evaluation, but you may be more comfortable if you bring a pair of shorts (for a lower extremity evaluation) or a t-shirt (for an upper extremity or spinal evaluation).
How long is each visit?
Depending upon the complexity of your needs, appointments range from 15 to 90 minutes.
Will the item/service requested by the physician be available at the first appointment?
We keep a large inventory of orthoses on hand, so we may be able to meet your needs in one appointment. If we do not have the particular device prescribed, and a substitution is not permissible, we can order a device for you. In most cases, we would be able to fit you within a couple of days.
How long will it take to receive my custom-made orthosis or prosthesis?
The fabrication time will vary depending on the complexity of the device. Most orthotic and prosthetic services require between 1 to 3 weeks to be completed. For complex designs, you can expect to be seen for a fitting within 1 to 2 weeks. Additional fittings, if necessary, continue weekly until completion of the device.
Are follow-up and adjustment appointments included as part of the total service?
There is no charge for follow-up appointments for the first 90 days. During this period, we provide fine-tuning adjustments to optimize the fit and function of the device. There may be a charge for adjustments or modifications that become necessary as result of a change in your condition, or for anatomical changes including growth or weight gain/loss. If you misuse or abuse your device, there will be a charge for repairs.
How often do I need to replace my orthosis or prosthesis?
Most orthoses/prostheses will last for several years. If you gain or lose a significant amount of weight, or if you grow (in the case of a child), you may require a replacement sooner. We recommend a yearly follow-up with your practitioner to assess the effectiveness and safety of your current orthosis/prosthesis. We encourage you to call immediately if you notice a decrease in effectiveness or comfort, or if there is a change in the performance of your device.
What is your warranty policy?
The warranty period for custom orthoses and prostheses is three months for workmanship and materials.
It is in your best interest to communicate with your practitioner on a timely basis and to allow us to resolve any problems you are experiencing as efficiently and quickly as possible. We will make every attempt to meet your needs.
What is your return/exchange policy?
Prefabricated O&P devices and durable medical equipment purchased from Strong Orthotics and Prosthetics may be exchanged or returned and the account credited if all the following criteria are met:
Special or custom orders are not returnable or refundable. No refund or exchange will be issued for items that were not used in accordance with the manufacturer's guidelines.
If a device is no longer needed (change in diagnosis, alternate treatment sought, change in health status, death, etc.) and it is only slightly worn, can it be returned for credit or refund?
Devices that have been worn cannot be used on other patients, and therefore cannot be returned for credit.
