Aetna prosthetics and orthotics coverage
We handle the paperwork. You focus on recovery.
Aetna covers custom prosthetics and orthotics—and Orthotics Ltd manages the entire insurance process from start to finish. Prescriptions. Prior authorization. Claims. We take care of it so you can focus on getting back on your feet.
What Aetna covers
Prosthetic devices
Aetna covers medically necessary prosthetic devices, including:
- Lower limb prosthetics (below knee, above knee, partial foot, hip disarticulation)
- Upper limb prosthetics (below elbow, above elbow, partial hand, shoulder disarticulation)
- Pediatric prosthetics (with coverage for growth-related replacements)
- Bionic and myoelectric prosthetics (when medically necessary)
- Prosthetic socket replacements and adjustments
- Cosmetic covers and sleeves
Orthotic devices
Aetna covers custom orthotic devices, including:
- Custom braces (ankle, knee, wrist, elbow, back, neck)
- Compression garments
- Spinal orthotics
- Custom-molded shoes and inserts
- Orthotic repairs and adjustments
Additional covered services
- Initial consultation and evaluation
- Custom fitting and adjustments
- Follow-up care and modifications
- Repairs and replacements (when medically necessary)
How Aetna coverage works
01
Get a prescription
Your physician provides a prescription for the prosthetic or orthotic device. We can help coordinate with your doctor's office if needed.
02
We verify your benefits
We contact Aetna to verify your coverage, check your deductible, and confirm what you'll owe out-of-pocket. You'll know the costs before we begin.
03
We submit prior authorization (if needed)
Some Aetna plans require prior authorization for prosthetics and orthotics. We handle all the paperwork and follow up with Aetna's review team.
04
We create your custom device
Once approved, we scan or cast your limb, create a test socket or device, and work with you until the fit is perfect.
05
We bill Aetna directly
After delivery, we submit claims directly to Aetna. You'll receive an Explanation of Benefits showing what Aetna paid and any remaining balance.
What you'll pay with Aetna
Understanding your out-of-pocket costs
Your costs depend on your specific Aetna plan:
Deductible (if not yet met)
Coinsurance (typically 10-20% after deductible)
Copay (for some plans)
Once you reach your out-of-pocket maximum, Aetna covers 100% of costs for the rest of the plan year.
Aetna Medicare Advantage
If you have Aetna Medicare Advantage, prosthetics and orthotics are covered under Medicare Part B guidelines. Most beneficiaries pay 20% coinsurance after meeting the Part B deductible.
We tell you what to expect upfront
Before we begin fabrication, we'll provide a clear estimate of your financial responsibility. No surprises.
Why Orthotics Ltd makes Aetna coverage easy
We verify benefits before you commit
You'll know exactly what Aetna covers and what you'll owe before we start creating your device.
We handle all prior authorizations
If your Aetna plan requires prior authorization, we submit all documentation and follow up until it's approved.
We bill Aetna directly
You don't submit claims. We handle all billing and follow up with Aetna on your behalf.
We work with your doctor
We coordinate with your physician's office to ensure we have all necessary prescriptions and medical documentation.
50+ years of insurance experience
We've worked with Aetna for decades. We know their requirements, their timelines, and how to get approvals efficiently.
Helpful Aetna resources
Log in to check your benefits, view claims, and access your health information.
Search for in-network providers (Orthotics Ltd is in-network with most Aetna plans).
Contact Aetna with questions about your plan or benefits. Customer Service: 1-800-872-3862
Information for Aetna Medicare Advantage members.
Learn about durable medical equipment and prosthetics coverage.
Common questions about Aetna coverage
Does Aetna cover prosthetics and orthotics?
Yes. Aetna covers medically necessary prosthetic and orthotic devices prescribed by your physician.
Do I need a referral?
It depends on your plan type. PPO plans typically don’t require referrals; HMO plans often do. We’ll verify this when we check your benefits.
How long does Aetna authorization take?
Prior authorization typically takes 5-10 business days. We follow up with Aetna throughout the process.
Does Aetna cover pediatric prosthetics?
Yes. Aetna covers pediatric prosthetics and allows for replacements as children grow.
What if my prosthetic needs repairs?
Aetna covers medically necessary repairs and adjustments. We submit claims for covered repair services.
Does Aetna cover bionic or myoelectric prosthetics?
Yes, when medically necessary and prescribed by your physician. We work with Aetna to demonstrate medical necessity.
How often can I get a replacement prosthetic?
Replacement frequency depends on medical necessity. Typical replacement timelines are 3-5 years for adults, more frequently for children due to growth.
What if Aetna denies coverage?
If Aetna denies coverage, we file an appeal with supporting clinical documentation. We’ve successfully appealed many denials.
Locations serving Aetna members
Orthotics Ltd serves ArchCare members throughout New York.
Our clinic:
Harriman, NY
We also offer:
- Home visits for patients who can’t travel
- Nursing home partnerships
- Emergency prosthetic services
Ready to use your Aetna benefits?
