Common Insurance Documents

Footy Custom Orthotics are covered by most Extended Health Benefits Plans and/or Health SpendingA ccounts (HSA).

Below is a list of the documentation that can be required by some insurance providers.

Predetermination Request:

If you wish to contact your Insurance provider prior to placing your order to determine if your orthotic purchase is eligible for coverage, please please complete the INSURANCE DOCUMENTATION FORM (Button is on bottom right of the screen) or email us at info[@]

We will forward you a Sample Receipt, as well as a Sample Proof of Manufacture & Biomechanical Report. These documents can be sent to your Insurance and Benefit (Third Party) Provider for Predetermination eligibility.

Once you have submitted the Predetermination Request Form, you will receive the document within the hour.

Please note: Your insurance provider may simply send you details regarding your plan's eligibility, which does not necessarily mean that FOOTSY will meet all of their requirements. Please cross reference your plan's needs,
with the services and documents that FOOTSY provides.

Ordering For Multiple People:

We would like to ensure that you have the best possible experience with FOOTSY and the subsequent submittal for reimbursement.

If you are ordering for yourself, as well as for another individual and are seeking reimbursement, we would recommend that the orders be placed separately. Each order will then receive its own separate Invoice and related documentation, which is often a requirement of insurance coverage.

 If you place a single order for multiple claimants, all documentation will be in the name of the person who placed the order. Please be aware, you may then encounter problems when you submit to Insurance. It is always recommended that you contact your insurance company for details specific to your plan.


FOOTSY’s are unique to each of our clients, they are made for YOUR FEET ALONE, no two FOOTSY’s are the same! We bring the experience of getting Orthotics to you.