Fidelis Care prosthetics and orthotics coverage
We handle the paperwork. You focus on recovery.
Fidelis Care 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 Fidelis Care covers
Prosthetic devices
Fidelis Care 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
Fidelis Care 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 Fidelis Care coverage works
Understanding Fidelis Care plan types
Fidelis Care offers multiple plan types in New York:
- Medicaid Managed Care (no cost-sharing for most members)
- Child Health Plus
- Essential Plan (low-cost marketplace plan)
- Qualified Health Plans (marketplace plans)
- Medicare Advantage (Fidelis Medicare)
Dual Advantage (Medicare and Medicaid)
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 Fidelis Care to verify your coverage and confirm what you'll owe out-of-pocket based on your plan type.
03
We submit prior authorization
Fidelis Care requires prior authorization for prosthetics and orthotics. We handle all documentation and follow up with Fidelis Care'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 Fidelis Care directly
After delivery, we submit claims directly to Fidelis Care. You'll receive an Explanation of Benefits showing what Fidelis paid and any remaining balance.
What you'll pay with Fidelis Care
Medicaid Managed Care members
If you have Fidelis Care through New York Medicaid, prosthetics and orthotics are covered with no copays, deductibles, or out-of-pocket costs.
Medicare Advantage members
Fidelis Medicare members pay according to Medicare Part B guidelines:
Medicare Part B deductible (if not yet met)
20% coinsurance after deductible
Some Fidelis Medicare plans offer enhanced benefits with lower cost-sharing.
Essential Plan and marketplace members
Cost-sharing depends on your specific plan and metal tier (Bronze, Silver, Gold, Platinum). We'll verify your exact costs during the benefits check.
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 Fidelis Care coverage easy
We verify benefits before you commit
You'll know exactly what Fidelis Care covers and what you'll owe before we start creating your device.
We handle all prior authorizations
We submit all documentation to Fidelis Care and follow up until authorization is approved.
We bill Fidelis Care directly
You don't submit claims. We handle all billing and follow up with Fidelis 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.
We speak your language
Fidelis Care serves diverse New York communities. We work with patients who speak English, Spanish, and other languages.
Helpful Fidelis Care 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 Fidelis Care).
Contact Fidelis with questions about your plan or benefits. Customer Service: 1-888-343-3547
Information for Medicaid members.
Common questions about Fidelis Care coverage
Does Fidelis Care cover prosthetics and orthotics?
Yes. Fidelis Care covers medically necessary prosthetic and orthotic devices across all plan types.
Do I need a referral?
It depends on your plan type. Medicaid managed care plans typically require referrals; some Medicare Advantage plans do as well. We’ll verify this when we check your benefits.
How long does Fidelis Care authorization take?
Prior authorization typically takes 5-10 business days. We follow up with Fidelis throughout the process.
Does Fidelis Care cover pediatric prosthetics?
Yes. Fidelis Care covers pediatric prosthetics and allows for replacements as children grow.
What if my prosthetic needs repairs?
Fidelis Care covers medically necessary repairs and adjustments.
Does Fidelis Care cover bionic or myoelectric prosthetics?
Yes, when medically necessary and prescribed by your physician.
I have Medicaid through Fidelis. Will I owe anything?
Most Medicaid members have no out-of-pocket costs for medically necessary prosthetics and orthotics.
Locations serving Fidelis Care members
Orthotics Ltd serves Fidelis Care 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 Fidelis Care benefits?
