Types of Funding
We understand that accessing funding for Orthotic Treatments can be complicated and stressful, so at Ortho Dynamics we aim to make things as simple as possible.
Funding for your Orthosis may require self-payment, third party insurance, and/or government funding agencies. Some funding agencies will provide full or partial funding for your Orthotic Management, depending on several factors, including personal family income, level of disability, and may be dependent on your age. All funding agencies require pre-authorization for funding. During your first appointment with us, we will help determine your funding eligibility and options and provide you with the necessary paperwork.
All funding agencies and private insurance companies will need to know if your Orthosis was prescribed by a Doctor or Specialist, the materials that it is fabricated from, whether it was provided by a Certified Orthotist, and whether it will be used full time to determine your eligibility.
Private insurance companies may require you to first apply through Pharmacare to see if a portion of the cost will be covered as first payer. Please check with your private insurance to determine their criteria. Private insurance and some funding agencies may require a biomechanical assessment or letter validating the need for the Orthotic Treatment. We are pleased to be able to provide these documents for you.
We accept the following payment methods
- Certified Cheques
Pharmacare: If you have been prescribed an Orthosis that qualifies under Pharmacare benefits it is our recommendation that you register with PharmaCare if you are not yet registered. The PharmaCare program helps eligible British Columbia residents with the expense of designated orthoses for youth aged 18 or younger. Most BC residents are eligible for assistance under Fair PharmaCare, a BC PharmaCare plan that provides assistance based on income and requires a one-time registration.
There are different types of Pharmacare plans that dictate the level of funding each patient could receive. For example, most people qualify for Plan I, which requires a deductible to be met before Pharmacare will assist with funding, where the deductible is based on personal family income from the previous tax year. When we submit the approved cost to Pharmacare, the amount will go towards your deductible. Plan C provides funding for families on the social services program for the maximum amount that Pharmacare will fund of the Orthotic Treatment based on their criteria and the type of Orthosis. Plan F provides funding for children up to 18 years old if their medical condition limits their physical ability to be independent in their ability to walk or meet certain milestones due to their underlying condition or pathology. If you do qualify for Plan F or C, we will complete and submit the paperwork for you as it needs to be approved before the provision of your Orthosis.
Please be aware that Pharmacare does not cover 100% of the cost of Orthotic Treatments and that patients are responsible for any outstanding amount. To register or to find out if you’re registered with PharmaCare please phone: Vancouver 604-683-7151 / The rest of BC 1-800-663-7100.
Pharmacare benefits qualifying for funding include AFOs, SMOs, TLSOs, KAFOs, and Hip Orthoses. However, Custom Foot Orthoses, Upper Extremity Orthoses, and Twisters do not qualify. The Orthosis must be custom, provided by a Certifee and prescribed for full time use for the long term in order to qualify. Pharmacare will not provide more than one type of Orthosis per year. For the full criteria please see Pharmacare Orthotic Program.
At Home Program: This Medical Plan only covers children ages 0-18 who are unable to be independent in their mobility or other care due to an underlying condition or pathology (Those eligible are considered Plan F under Pharmacare Benefits). Patients must apply and be accepted into the At Home program, which covers Custom FOs, WHOs, EOs, COs, Twisters and some off-the-shelf items, and shoes or shoe lifts based on their discretion. The At Home program funds 1 new Orthosis/adjustment per year.
Ministry of Social Development and Social Innovation: For patients previously on the At Home program who are over the age of 18, the Ministry provides funding towards eligible Orthoses. Pre-authorization by the Ministry is required for Orthoses, which may take several months to be processed. If you qualify for this type of funding, it is important that we begin the funding process early, as appointments can only be booked once Ministry approval has been received. For families which qualify for this funding program due to low income, funding must also be pre-authorized before any appointments can be booked and children under the age of 19 are considered to be under Plan C for Pharmacare Benefits.
NIHB: All funding applications for Orthoses or adjustments under the NIHB program must be pre-approved. Their criteria for funding requires Orthotic Treatment by a qualified Certified Orthotist, prescription from a Doctor or Specialist, and there are no age limits for funding benefits. The Orthotic request must fall under the accepted categories of Orthotic Treatment.
We are also on the list of authorized clinics for the following Governmental Funding Agencies:
- Worksafe BC
- Interim Federal Health Program
- Veterans Affairs Canada
There are numerous non-governmental organization that help fund Orthoses, in particular for children. While we generally only work with a small number of these organizations, we try to connect our patients with appropriate assistance for funding if required. Below are the organizations providing much needed funding for many families in B.C.
Variety Children's Charity: It is the responsibility of the patient's parents/legal guardians to complete and submit the application to Variety. Documentation such as justification letters and estimates for the Orthosis will be provided by our office to complete your application. Variety applies their multifactorial criteria to determine eligibility depending on the need of the patient. Patients must also be registered with Pharmacare and funding must be applied for through Pharmacare or other first payer first.
The Spina Bifida and Hydrocephalus Association of British Columbia: The SBHABC is a non-governmental organization that helps improve the quality of life for patients with Spina Bifida. Applications can be made to receive funding for the portion not covered by other funding agencies (up to $1,000CAD), including Pharmacare and extended health.
Extended Health Care
Our office is not able to directly bill insurance companies unless there is an approved Assignment of Payment. Patients must pay us in full and submit the invoice to their insurance company for reimbursement*. However, we are happy to provide extra information for insurance companies if they require it.
*If the cost of the orthosis exceeds $1,000 CAD, some insurance companies will allow Assignment of Payment, which allows us to bill them directly. However, the application to the insurance companies should be completed as early as possible to prevent further delays.
Our Financial Policy
An estimate of cost for the Orthosis will be provided at the initial appointment based on the requirements of the client, and payment options will be discussed. Our office is linked to Pharmanet online, providing quick processing once pre-approval is received. The client is responsible for any portion of the cost not covered by a funding agency or extended health insurance. Once full payment is made, a receipt will be issued for claims purposes. Payment is due upon receipt of the Orthosis, unless prior arrangements have been made with Ortho Dynamics. Our Office Manager can assist with determining the payment method that best suits the client’s needs.