Insurance Paying for Knee Braces

ChubbyCat113
Posts
213
Joined
1/26/2016
Location
Wheelersburg, OH US
Tore ACL, MCL, and Meniscus. How did you guys go about getting insurance to pay for your MX knee braces and what brand did you get? I was wearing some older asterisk braces so looking to get new braces for next year.
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mister2dt
Posts
285
Joined
8/20/2018
Location
Canton, MS US
10/20/2020 7:53am
Talk to your ortho surgeon, have him write your insurance company a needs letter and prescription. He can bring in a rep to measure your leg/ legs, use those dimensions to sway the insurance company to spring for custom braces vs the off the shelf braces they will want to pay for
2
kdawson252
Posts
118
Joined
7/13/2017
Location
Washougal, WA US
11/14/2020 12:15pm
Just went through the same injury. Insurance just denied my claim for a custom brace. My surgeon informed me that it was a very slim chance to get them covered these days even with a prescription. Also my insurance is absolute trash so there's that.
1
YZ-MTB
Posts
128
Joined
2/5/2019
Location
OR US
11/14/2020 12:31pm
I started looking into this, but my insurance would have only covered a brace for my injured knee (if they approved it at all) and with deductible I would have been paying most if not all out of pocket for 1 brace, and 100% for the other brace. I ended up just buying a set of asterisk carbon cells which I am happy with.
berm surfer
Posts
195
Joined
1/4/2020
Location
NorCal, CA US
11/14/2020 12:46pm
Same situation for me as the post above. Was better off just buying them myself.

The Shop

MudPup545
Posts
1691
Joined
11/14/2014
Location
Imlay City, MI US
11/14/2020 12:50pm
Asked my doctor about them, even showed her the ad stating that insurance may cover it. She pretty much told me that there was no way in Hell insurance would cover it and added, “what! You expect them to pay for your helmet too?”
1
dl117
Posts
1549
Joined
2/8/2007
Location
Cambridge, MN US
Fantasy
2577th
11/14/2020 6:33pm
I brought a cti brochure in to my surgeon and he lined up the fitting and made sure insurance paid it. But that was a while ago, and the denied the 2nd one, only got one for the repaired knee
Electro21
Posts
1975
Joined
6/11/2008
Location
Dumfries, VA US
Fantasy
75th
11/14/2020 6:47pm
Tricare! I got a CTi less than a year ago for a knee surgery that occurred before joining the Army. Surgery was in 1997.
2
8tensolutions
Posts
2406
Joined
11/15/2009
Location
Salt Lake City, UT US
11/14/2020 7:21pm
Mine paid for both. You just need the right surgeon that you have a relationship with and they can make it happen. The CTI (ossur) rep can tell you exactly what is required.
1
1
1stSSPZ
Posts
260
Joined
3/17/2014
Location
Lubbock, TX US
2/15/2023 4:04am
Electro21 wrote:
Tricare! I got a CTi less than a year ago for a knee surgery that occurred before joining the Army. Surgery was in 1997.

Same here. Tricare bought my first set of CTi’s and the VA (!) bought the second pair.

2/15/2023 5:15am

I had an ACL reconstruction back in 2011. Went with Asterisks for a year, then I decided to make an appointment with the surgeon to talk to them about getting CTI's. He ended up writing a prescription for both knees. came out of pocket roughly $300. Its worth a try and depending on your insurance and how cool or doc is you can get a set pretty easy. 

Log Hopper
Posts
266
Joined
6/17/2016
Location
MN US
Fantasy
1586th
2/15/2023 7:23am

After tearing up one knee and getting an insurance brace my doctor told me you should exercise more and I said my form of exercise is riding dirt bikes and I'm uncomfortable riding without a brace on my other knee. he wrote me the prescription for the other knee. I didn't even finish my story and he was writing it up. Attaboy! 

mikelawlor
Posts
83
Joined
12/4/2022
Location
Johnsonville, NY US
2/15/2023 8:01am

I got both of mine covered but it took a little bit. I had my surgeon write a letter stating I needed them for support and that I do construction and walk up and down ladders everyday (which is true) and that the other leg should have one as a preventative measure rather than needing a surgery for it down the line. I sent it in and a month later I got a letter back from insurance saying they will cover them both. Cost me about $100 out of pocket for CTI custom braces. I also got them through a orthopedic specialist who deal with prosthetics and braces and wheelchairs so they knew all the right things to say. 

Moto520
Posts
3387
Joined
2/4/2013
Location
Schaumburg, IL US
2/15/2023 8:27am

I got my CTI brace covered by insurance after an ACL repair.  Most doctors should have no problem writing up a script for it....i don't know why they wouldn't do that.

crusher773
Posts
1757
Joined
12/23/2009
Location
Coweta, OK US
2/16/2023 11:47am

I just had my primary care write a script for CTIs.  They paid for them no problem.  I had torn an ACL back about 20 years ago.  

1
ToolMaker
Posts
6097
Joined
11/19/2011
Location
Escondido, CA US
Fantasy
762nd
2/16/2023 5:40pm

If you have good insurance they might go for it. Bring some studies to the Dr. to back up that it is preventative. Our insurance bought a pair for my son so he wouldn't have problems. I think he has the CTI, not sure

TM

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