Durable Medical Equipment
Functional (ACL, MCL & Meniscus) & Osteoarthritis (OA) Off The Shelf (OTS) And Custom Knee Brace Process
The process begins once your physician has given his Medical Assistant (MA) a script that is relevant to your problem. The script is then given to me so that I might contact you concerning a day and time to measure you for the prescribed brace. If, based on your insurance, an OTS is required three measurements of your knee will be taken; 6” above your kneecap, 6” below your kneecap and a width measurement at the center of your knee. If, based on your insurance, you can be fitted with a custom brace a cast mold will be made of your leg and removed as soon as it dries. Once the measurements or the cast mold have been completed the order form will be given to our DME Coordinator who will contact your insurance company to determine your insurance benefits. Once she has this information you will be contacted to determine if you would like to proceed with the ordering process. Any money owed would be collected at that time.
The packet will then be given to me to place your order. OTS braces are faxed to the brace manufacturer and the cast molds are shipped. When the fabrication process has been completed you will be notified and an appointment will be scheduled to fit you with your brace. OA brace patients are brought back for a two week follow-up to see if any adjustments need to be made.
OTS vs Custom Braces
Why some insurance companies will not provide coverage
There are three categories of braces available to be dispensed to the patient: Off The Shelf (OTS), Custom or Customized.
The standard OTS comes from two measurements of the leg; one six inches above mid patella and one six inches below mid patella. These measurements tell us whether the patient will require an x-small, small, medium, large, or x-large brace.
In order to fit the patient with a custom brace it is necessary to cast the leg and then remove it. The completed cast mold will be sent to the manufacturer and a mold will be made of their leg and the brace will be fabricated to the mold.
Not everyone’s leg will fall under the category of small, medium or large for one reason or another, therefore, in order to make a customized version of the brace a third measurement, measuring the width of the knee, will be taken. This allows us to put our patients in as close to a custom brace as possible.
There are many factors that determined how much your insurance company will pay for your knee brace. Some of these include; deductibles, out of pocket expenses met, copays, etc. In addition, there are several insurance companies that will not provide coverage for a custom knee brace but will provide coverage for an OTS or Customized. The thought behind this is that an OTS will protect the knee just as efficiently as a custom brace. In many ways this thought process is accurate, however, with a custom brace it is fabricated exactly to the shape of your leg and provides the absolutely best fit possible.
