UnitedHealthcare prosthetics and orthotics coverage
We handle the paperwork. You focus on recovery.
UnitedHealthcare 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 UnitedHealthcare covers
Prosthetic devices
UnitedHealthcare 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
UnitedHealthcare 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 UnitedHealthcare coverage works
Understanding UnitedHealthcare plan types
UnitedHealthcare offers multiple plan types in New York:
- UnitedHealthcare Medicare Advantage (HMO, PPO plans)
- UnitedHealthcare Community Plan (Medicaid)
- UnitedHealthcare Dual Complete (Medicare and Medicaid)
- UnitedHealthcare Commercial plans (employer-sponsored)
- UnitedHealthcare 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 UnitedHealthcare to verify your coverage, check your deductible, and confirm what you'll owe out-of-pocket.
03
We submit prior authorization (if needed)
Most UnitedHealthcare plans require prior authorization for prosthetics and orthotics. We handle all documentation and follow up with UnitedHealthcare'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 UnitedHealthcare directly
After delivery, we submit claims directly to UnitedHealthcare. You'll receive an Explanation of Benefits showing what UHC paid and any remaining balance.
What you'll pay with UnitedHealthcare
Medicare Advantage members
UnitedHealthcare Medicare Advantage members pay according to Medicare Part B guidelines:
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 UHC Medicare Advantage plans offer enhanced benefits with lower cost-sharing.
Medicaid (Community Plan) members
If you have UnitedHealthcare Community Plan through New York Medicaid, prosthetics and orthotics are covered with no copays, deductibles, or out-of-pocket costs.
Commercial plan members
Cost-sharing depends on your specific employer-sponsored or individual plan:
- Deductible (if not yet met)
- Copay or coinsurance per item
- Out-of-pocket maximum
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 UnitedHealthcare coverage easy
We verify benefits before you commit
You'll know exactly what UnitedHealthcare covers and what you'll owe before we start creating your device.
We handle all prior authorizations
We submit all documentation to UnitedHealthcare and follow up until authorization is approved.
We bill UnitedHealthcare directly
You don't submit claims. We handle all billing and follow up with UHC 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 UnitedHealthcare for decades. We know their requirements and how to get approvals efficiently.
Helpful UnitedHealthcare 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 UHC plans).
Contact UnitedHealthcare with questions about your plan or benefits.
Medicare Advantage: 1-866-414-1959
Commercial Plans: 1-866-414-1959
Community Plan (Medicaid): 1-800-493-4647
Learn about Medicare Part B coverage for prosthetics and orthotics.
Common questions about UnitedHealthcare coverage
Does UnitedHealthcare cover prosthetics and orthotics?
Yes. UnitedHealthcare covers medically necessary prosthetic and orthotic devices across all plan types.
Do I need a referral?
It depends on your plan type. UHC HMO plans typically require referrals; PPO plans often do not. We’ll verify this when we check your benefits.
How long does UnitedHealthcare authorization take?
Prior authorization typically takes 5-10 business days. We follow up with UHC throughout the process.
Does UnitedHealthcare cover pediatric prosthetics?
Yes. UnitedHealthcare covers pediatric prosthetics with coverage for growth-related replacements.
What if my prosthetic needs repairs?
UnitedHealthcare covers medically necessary repairs and adjustments.
Does UnitedHealthcare 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 UnitedHealthcare members
Orthotics Ltd serves UnitedHealthcare 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 UnitedHealthcare benefits?
