Anthem prosthetics and orthotics coverage
We handle the paperwork. You focus on recovery.
Anthem 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 Anthem covers
Prosthetic devices
Anthem 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
Anthem 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 Anthem coverage works
Understanding Anthem plan types
Anthem (Blue Cross Blue Shield) offers multiple plan types in New York:
- Anthem Blue Cross Blue Shield PPO
- Anthem Blue Cross Blue Shield HMO
- Anthem Medicare Advantage
- Anthem Medicaid (in select states)
- Anthem employer-sponsored plans
- Anthem Individual & Family Plans (marketplace)
Coverage and cost-sharing vary by plan type. We’ll verify your specific benefits.
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 Anthem to verify your coverage, check your deductible, and confirm what you'll owe out-of-pocket.
03
We submit prior authorization (if needed)
Most Anthem plans require prior authorization for prosthetics and orthotics. We handle all documentation and follow up with Anthem'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 Anthem directly
After delivery, we submit claims directly to Anthem. You'll receive an Explanation of Benefits showing what Anthem paid and any remaining balance.
What you'll pay with Anthem
Understanding your out-of-pocket costs
Your costs depend on your specific Anthem plan:
Medicare Advantage members
MetroPlus Senior (Medicare Advantage) members pay according to Medicare Part B guidelines:
Deductible (if not yet met)
Coinsurance (typically 10-20% after deductible)
Copay (for some plans)
Once you reach your out-of-pocket maximum, Anthem covers 100% of costs for the rest of the plan year.
Anthem Medicare Advantage
If you have Anthem 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 Anthem coverage easy
We verify benefits before you commit
You'll know exactly what Anthem covers and what you'll owe before we start creating your device.
We handle all prior authorizations
If your Anthem plan requires prior authorization, we submit all documentation and follow up until approved.
We bill Anthem directly
You don't submit claims. We handle all billing and follow up with Anthem 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 Blue Cross Blue Shield plans for decades. We know how Anthem works.
Helpful Anthem 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 Anthem plans).
Contact Anthem with questions about your plan or benefits. Customer Service: 1-833-707-0466
Learn about durable medical equipment coverage.
Common questions about Anthem coverage
Does Anthem cover prosthetics and orthotics?
Yes. Anthem covers medically necessary prosthetic and orthotic devices across all plan types.
Do I need a referral?
It depends on your plan type. Anthem HMO plans typically require referrals; PPO plans often do not. We’ll verify this when we check your benefits.
How long does Anthem authorization take?
Prior authorization typically takes 5-10 business days. We follow up with Anthem throughout the process.
Does Anthem cover pediatric prosthetics?
Yes. Anthem covers pediatric prosthetics with coverage for growth-related replacements.
What if my prosthetic needs repairs?
Anthem covers medically necessary repairs and adjustments.
Does Anthem cover bionic or myoelectric prosthetics?
Yes, when medically necessary and prescribed by your physician.
How often can I get a replacement prosthetic?
Replacement frequency depends on medical necessity. Typical guidelines allow replacement every 3-5 years.
Locations serving Anthem members
Orthotics Ltd serves Anthem 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 Anthem benefits?
