Somos prosthetics and orthotics coverage
We handle the paperwork. You focus on recovery.
Somos 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 Somos covers
Prosthetic devices
Somos 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
Somos 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 Somos coverage works
Understanding Somos
Somos Community Care is an Independent Practice Association (IPA) that works with various health plans to coordinate care for New York Medicaid and Medicare members. Somos partners with health plans including Fidelis Care, Healthfirst, MetroPlusHealth, United Healthcare Community Plan, and others.
If you’re a Somos member, you have both a health plan and a Somos provider network.
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 your health plan to verify your coverage and confirm what you'll owe out-of-pocket.
03
We submit prior authorization
Your health plan requires prior authorization for prosthetics and orthotics. We handle all documentation and follow up until approved.
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 your health plan directly
After delivery, we submit claims directly to your health plan. You'll receive an Explanation of Benefits showing what was paid and any remaining balance.
What you'll pay with Somos
Medicaid members
If you have Somos through New York Medicaid (with health plans like Fidelis, Healthfirst, MetroPlus, or UHC Community Plan), prosthetics and orthotics are covered with no copays, deductibles, or out-of-pocket costs.
Medicare members
If you have Somos through a Medicare Advantage plan, you'll pay according to Medicare Part B guidelines:
Medicare Part B deductible (if not yet met)
20% coinsurance after deductible
Some Medicare Advantage plans offer enhanced benefits with lower cost-sharing.
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 Somos coverage easy
We verify benefits before you commit
You'll know exactly what your health plan covers and what you'll owe before we start creating your device.
We handle all prior authorizations
We submit all documentation to your health plan and follow up until authorization is approved.
We bill your health plan directly
You don't submit claims. We handle all billing and follow up 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 New York's Latino communities
Somos primarily serves Latino communities in New York City. We work with Spanish-speaking patients and understand the cultural context.
Helpful Somos resources
Learn about Somos and find participating providers.
Contact Somos with questions about your care coordination. Member Services: 1-844-766-6701
Log in to your health plan (Fidelis, Healthfirst, MetroPlus, etc.) to check benefits and view claims.
Information for Medicaid members.
Common questions about Somos coverage
Does Somos cover prosthetics and orthotics?
Yes. Somos members have coverage through their health plan (Fidelis, Healthfirst, MetroPlus, UHC Community Plan, etc.), which covers medically necessary prosthetic and orthotic devices.
Do I need a referral?
Most Somos members are on Medicaid managed care plans that require referrals from your primary care physician. We’ll verify this when we check your benefits.
How long does authorization take?
Prior authorization typically takes 5-10 business days. We follow up with your health plan throughout the process.
Does Somos cover pediatric prosthetics?
Yes. Somos members with Child Health Plus or Medicaid have coverage for pediatric prosthetics, including growth-related replacements.
What if my prosthetic needs repairs?
Your health plan covers medically necessary repairs and adjustments.
Does Somos cover bionic or myoelectric prosthetics?
Yes, when medically necessary and prescribed by your physician.
I have Medicaid through Somos. Will I owe anything?
Most Medicaid members have no out-of-pocket costs for medically necessary prosthetics and orthotics.
Do you speak Spanish?
We work with Spanish-speaking patients and can coordinate care in Spanish.
Locations serving Somos members
Orthotics Ltd serves Somos 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 Somos benefits?
