MetroPlusHealth prosthetics and orthotics coverage
We handle the paperwork. You focus on recovery.
MetroPlusHealth 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 MetroPlusHealth covers
Prosthetic devices
MetroPlusHealth 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
MetroPlusHealth 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 MetroPlusHealth coverage works
Understanding MetroPlusHealth plan types
MetroPlusHealth 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)
- Medicare Advantage (MetroPlus Senior)
- Dual Advantage (Medicare and Medicaid)
Qualified Health Plans (marketplace plans)
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 MetroPlusHealth to verify your coverage and confirm what you'll owe out-of-pocket based on your plan type.
03
We submit prior authorization (if needed)
MetroPlusHealth requires prior authorization for prosthetics and orthotics. We handle all documentation and follow up with MetroPlus'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 MetroPlusHealth directly
After delivery, we submit claims directly to MetroPlusHealth. You'll receive an Explanation of Benefits showing what MetroPlus paid and any remaining balance.
What you'll pay with MetroPlusHealth
Medicaid Managed Care members
If you have MetroPlusHealth through New York Medicaid, prosthetics and orthotics are covered with no copays, deductibles, or out-of-pocket costs.
Medicare Advantage members
MetroPlus Senior (Medicare Advantage) members pay according to Medicare Part B guidelines:
Medicare Part B deductible (if not yet met)
20% coinsurance after deductible
Some MetroPlus Medicare plans offer enhanced benefits with lower cost-sharing.
Essential Plan and marketplace members
Cost-sharing depends on your specific plan. Essential Plan members often have very low or $0 cost-sharing. 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 MetroPlusHealth coverage easy
We verify benefits before you commit
You'll know exactly what MetroPlusHealth covers and what you'll owe before we start creating your device.
We handle all prior authorizations
We submit all documentation to MetroPlusHealth and follow up until authorization is approved.
We bill MetroPlusHealth directly
You don't submit claims. We handle all billing and follow up with MetroPlus 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 serve NYC's five boroughs
MetroPlusHealth primarily serves New York City. We work with patients throughout all five boroughs and surrounding areas.
Helpful MetroPlusHealth 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 MetroPlusHealth).
Contact MetroPlus with questions about your plan or benefits. Customer Service: 1-800-303-9626
Information for Medicaid members.
Common questions about MetroPlusHealth coverage
Does MetroPlusHealth cover prosthetics and orthotics?
Yes. MetroPlusHealth covers medically necessary prosthetic and orthotic devices across all plan types.
Do I need a referral?
Most MetroPlusHealth plans are HMOs and require referrals from your primary care physician. We’ll verify this when we check your benefits.
How long does MetroPlusHealth authorization take?
Prior authorization typically takes 5-10 business days. We follow up with MetroPlus throughout the process.
Does MetroPlusHealth cover pediatric prosthetics?
Yes. MetroPlusHealth covers pediatric prosthetics through Child Health Plus and other plans, with coverage for growth-related replacements.
What if my prosthetic needs repairs?
MetroPlusHealth covers medically necessary repairs and adjustments.
Does MetroPlusHealth cover bionic or myoelectric prosthetics?
Yes, when medically necessary and prescribed by your physician.
I have Medicaid through MetroPlus. Will I owe anything?
Most Medicaid members have no out-of-pocket costs for medically necessary prosthetics and orthotics.
Locations serving MetroPlusHealth members
Orthotics Ltd serves MetroPlusHealth 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 MetroPlusHealth benefits?
