Orthotics

This policy covers orthotic and related devices and services — including orthoses, prosthetics, diabetic therapeutic shoes and inserts, insulin pumps, blood glucose monitors and other supportive equipment — intended to improve function and quality of life for children with low‑tone neuromuscular, neurological, or cognitive impairments and for patients requiring diabetes management. Coverage requires physician prescription, is governed by the member’s specific benefit plan and applicable state law (many provisions apply only to fully insured Illinois plans or specified Arkansas mandates), excludes items that do not meet contract or statutory criteria, and is subject to limits such as customary replacement intervals (typically every three years) and exclusions for self‑funded/ASO groups unless otherwise indicated.

"Coverage of therapy necessary to increase quality of life for children clinically or genetically diagnosed with a disease, syndrome, or disorder that includes low-tone neuromuscular impairment, neu..."