Your doctor told you that you should see a podiatrist because you have diabetes. But is this service covered by insurance?
As health care changes in our country, the rules and regulations are changing, too. Also, every insurance plan is different. So, if you really want to know about your insurance coverage, you need to check with your insurance plan. But many insurance plans follow Medicare rules, and so in this article, I will try to explain Medicare coverage of podiatry services for patients with diabetes.
Let’s start with routine foot care. According to Medicare, it is “the cutting of nails and debridement of corns or calluses.” Routine foot care is covered when care by the patient or by a nonprofessional can cause a threat to the patient’s well-being, and this would be primarily when a person has decreased blood flow or decreased feeling in their legs or feet.
These problems are most commonly caused by diabetes. However, for those of you who do not have diabetes, you, too, can qualify for routine foot care if you have loss of feeling due to nerve damage (neuropathy) or poor circulation due to any other disease.
Usually, to ensure that the services are covered by Medicare, the patient must be under the active care of a doctor for the condition causing poor circulation or poor feeling. To know if routine foot care would be covered for you, it is best to ask your doctor if he or she has noted in your record poor circulation or poor feeling. Routine foot care can be provided under Medicare coverage every 60 days.
In addition to the care of toenails, corns and calluses and the treatment of warts on the feet is also covered.
Even if you are not interested in routine care, Medicare will cover an evaluation of the feet by a podiatrist every six months if you have loss of protective sensation. What is that? It means the loss of feeling due to neuropathy to the point that you may not feel an injury to your skin as it is occurring. That means you could develop an ulcer on one of your feet and not really know that it is happening.
LOPS is diagnosed with the monofilament test that your doctor does once a year. An evaluation every six months by a podiatrist, even without routine foot care, would be a way to learn more about how to prevent ulcers or worse. Such a prevention plan can include provision of shoes. No, the shoes don’t have to be big or ugly, they just need to be right for you. If you qualify (primarily because of diabetes plus LOPS or poor circulation), Medicare will cover a pair of shoes every calendar year.
Because feet are our means of getting to all the places we want to go in life, they are very important and must treated carefully. So, please feel free to call your local podiatrist for additional help for foot care services; remember you only get one life and one set of feet, so treat them with respect and care.
Christina L. Rowe is a doctor of podiatric medicine in State College. Contact her at 943-3668.