Comprehensive Information on Insurance Reimbursement for Sporlastic Orthopedic Braces and Supports

Sporlastic orthopedic braces and supports are designed to meet the requirements for insurance reimbursement in Canada. Below is a detailed guide to assist patients, healthcare providers, and insurance companies in navigating the reimbursement process for Sporlastic products.


Steps for Insurance Reimbursement

  1. Consult a Healthcare Provider
    Visit a licensed healthcare provider or physician to obtain a prescription for the required orthopedic device, including a diagnosis.

  2. Contact Your Insurance Provider
    Reach out to your insurance company to understand the specific procedures for filing a claim. Confirm whether your plan covers orthopedic braces and supports. In some cases, your healthcare provider may assist with this process.

  3. Purchase the Brace
    Once insurance approval is obtained, purchase the Sporlastic brace from your local dealer, authorized online retailers, or the official Sporlastic website. Ensure you receive a detailed receipt.

  4. Submit Required Documentation
    Provide the following documents to your insurance provider:

    • Prescription from your healthcare provider.
    • Invoice or receipt for the purchased brace.
    • Relevant HCPCS codes for the specific brace or support.
  5. HCPCS Codes for Classification
    Use the appropriate HCPCS (Healthcare Common Procedure Coding System) codes when submitting your claim. These codes ensure proper classification and eligibility for insurance reimbursement.


Common HCPCS Codes for Orthotic Devices

Upper Extremity Orthoses

  • Shoulder Orthoses

    • L3670: Acromioclavicular (canvas and webbing type), prefabricated.
    • L3675: Abduction restrainer, vest type, prefabricated.
  • Elbow Orthoses

    • L3760: Adjustable locking joint(s), prefabricated.
    • L3762: Rigid without joints, prefabricated.
  • Wrist-Hand-Finger Orthoses

    • L3807: Wrist-hand-finger orthosis, without joint(s), prefabricated.
    • L3915: Wrist-hand orthosis, rigid, prefabricated.

Lower Extremity Orthoses

  • Knee Orthoses

    • L1810: Elastic with joints, prefabricated.
    • L1845: Rigid support, adjustable knee joints, prefabricated.
  • Ankle-Foot Orthoses

    • L1902: Ankle gauntlet, prefabricated.
    • L1970: Plastic with ankle joint, custom-fabricated.
  • Hip Orthoses

    • L1686: Abduction control, flexible, prefabricated.
    • L1690: Abduction control, semi-rigid, prefabricated.

Spinal Orthoses

  • Cervical Orthoses

    • L0120: Flexible, non-adjustable, prefabricated (foam collar).
    • L0174: Semi-rigid, thermoplastic foam, prefabricated.
  • Thoracic-Lumbar-Sacral Orthoses (TLSO)

    • L0456: Rigid posterior panel, prefabricated.
    • L0462: Triplanar control, modular segmented system, prefabricated.

Orthopedic Footwear

  • L3224: Woman's orthopedic shoe, used as part of a brace.
  • L3225: Man's orthopedic shoe, used as part of a brace.

Insurance Providers and Coverage

In Canada, insurance coverage for orthopedic braces and supports is often included in extended health benefit plans. Coverage varies between providers, and the percentage of reimbursement depends on the individual policy. Below are some examples:

  • Medavie Blue Cross: Covers 70% of costs for braces, splints, and supports prescribed for musculoskeletal deficiencies.
  • Sun Life Financial: Reimburses up to a specific limit (e.g., $550 for custom orthotics) based on the policy.

It is essential to review your plan details or contact your insurance provider to confirm eligibility and reimbursement processes.


Important Notes

  • Sporlastic braces are designed for medical purposes and are not recommended for performance or recreational use.
  • Always consult your insurance company for detailed information on coverage, reimbursement percentages, and documentation requirements.
  • For additional assistance, Sporlastic customer service is available to guide you through the process or provide necessary product details to your insurance provider.