Knee Brace "Prescription"

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2/20/2018 12:00 PM

Guys,

I want to know the process to getting a set of knee braces covered under insurance post ACL surgery.

Who did you ask to recommend this? Your surgeon or your therapist?

Once they do recommend or write a prescription for the knee brace how do you go about recouping the money from the insurance company?

Want to know the best way to proceed......

Thanks!

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2/20/2018 12:09 PM
Edited Date/Time: 2/20/2018 12:25 PM

Your surgeon is the right person to ask. This person will be able to guide you in the right direction. You can sometimes work through your PT, but they will ultimately need a recommendation from the doctor, which they will surely do.

I had no problem getting a fancy $3000 carbon fiber CTi brace following a tibial platea fracture. Surely, your ortho will sign off on one for ACL injury. You may only be able to get one covered by insurance though - the one injured knee. They generally don't cover preventative stuff.

In short - ask your ortho surgeon but your insurance will ultimately dictate what's covered, and not. The request to your insurance to pay for a knee brace will need to come from your surgeon.

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2/20/2018 1:15 PM

My doctor used a friend of mine as the test subject to get the coding correct in order to get a set approved. After my friend got his, i got mine with ease. Your doctor will need to find out who the cti rep is in your area and request the paperwork. Fill it out and submit it. Takes about 3 weeks to recieve your braces. Bcbs has no problem covering a set for people with only one leg repaired. A couple grand is smarter on the bottom line verse tens of thousands for a repair

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2/20/2018 1:35 PM

Every situation and insurance company is different. Our family coverage is through the hospital where my wife works. Their insurance has something called "flexible spending" to cover things like this. My son's doctor simply wrote him a prescription for a set of Donjoy knee braces because he regularly complains of pain in his knees from football. We turned in the prescription and they approved the claim without question. I had to pay for the braces out of my own pocket and turn in a copy of my receipt and they wrote me a check within a couple of weeks to reimburse me. I guess they figured a set of knee braces is cheaper than knee surgery!

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2/20/2018 2:37 PM
Edited Date/Time: 2/20/2018 2:37 PM

Leatt offers an FDA Number to cover their X-Frame and C-Frame braces. Purchase the knee braces, then submit the provided FDA number for reimbursement. Just head to your local Leatt dealer!

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2/21/2018 10:44 AM

Lol I went to a walk in clinic to an unknown Dr and had him write me a script for knee instability. That’s all it took for me to get a $3500 set of custom CTi’s.

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