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Orthotics Consent From

Thank you for inquiring about orthotics through Tri & Run Sports. You need to know the following prior to your appointment if you plan on submitting a claim with your insurance company. To be clear this information is not required for ordering orthotics but rather for successfully claiming them.

    • Tri & Run Sports is not responsible for knowing or understanding the requirements of your insurance company.
    • It is YOUR responsibility to contact your insurance company to determine your individual requirements for payment.
    • 99% of the time your insurance company will require a Doctor’s note that PRE-dates your orthotic order. That means you should have one in your possession or know the requirements PRIOR to your orthotic appointment. Some of the possible issues that come up are: Doctor needs to see you to write the prescription, it must be written by a GP, Podiatrist, Chiropodist or other specified health professional. It ALWAYS needs to PRE-date your orthotic order.
    • You need to know your benefits such as dollars covered, how many pairs are covered and/or how often you are entitled to coverage.
    • You need to know what paperwork is required for filing.
    • If you are purchasing footwear with your orthotics you have 30 days to make certain they fit and you are happy with them. The orthotic company WILL NOT take them back if they have been worn outside or if it is past the 30 days.
    • You are required to pay 50% at the time of ordering. If you would like to start your orthotic claim you will be required to pay 100% at the time of ordering to receive all necessary paperwork.
    Dr's Notes requirements:
    Dollars Covered:
    Othotics allowed:
    Claim Period:
    Last Claim Date:
    I acknowledge that I have read and understood this information
    Name:
    Email:
    Phone:
    Click here for the form in PDF format

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