I found out today that Medicare and Tricare won't pay for a Podiatrist to make inserts for a heel spur. Who do I start with to get it funded?

SFC Everett Oliver — Wed, 13 Apr 2016 18:27:43 -0400

Response by SSG Mark Metzler made Apr 13 at 2016 6:58 PM

SSG Mark Metzler — Wed, 13 Apr 2016 18:58:21 -0400

You might try an Army or USAF Hospital. My wife obtained inserts from orthotics @ an USAF Hospital. No trouble @ all.

Response by Capt Private RallyPoint Member made Apr 13 at 2016 7:05 PM

Capt Private RallyPoint Member — Wed, 13 Apr 2016 19:05:24 -0400

My wife also gets inserts and adjustments thereto. I think maybe someone gave you bad information.

Response by CSM Bill Roy made Apr 13 at 2016 7:11 PM

CSM Bill Roy — Wed, 13 Apr 2016 19:11:25 -0400

Use VA if General Practioner won't send referral

Response by SFC Everett Oliver made Apr 13 at 2016 7:15 PM

SFC Everett Oliver — Wed, 13 Apr 2016 19:15:50 -0400

The point is that as a retiree forced onto Medicare and Tricare that they should be paying for this. I know where I could get it done and I know the cons to those options. So Far I paid a down payment of $75 with $210 to pay within 3 weeks when they are ready for me. And honestly I don't mind paying for service, but its not what we were promised.

Response by SGT Paul Mackay made Apr 13 at 2016 7:40 PM

SGT Paul Mackay — Wed, 13 Apr 2016 19:40:17 -0400

Response by MSG Les Amaya made Apr 13 at 2016 8:34 PM

MSG Les Amaya — Wed, 13 Apr 2016 20:34:21 -0400

Go to the VA!

Response by SGM Mikel Dawson made Apr 13 at 2016 9:47 PM

SGM Mikel Dawson — Wed, 13 Apr 2016 21:47:28 -0400

I got one of those darn things on my right foot. I went down to the store, got a good insert and off I go. I realize some are probably worse than others, so guess I'm lucky.

Response by LCDR Private RallyPoint Member made Apr 14 at 2016 12:46 AM

LCDR Private RallyPoint Member — Thu, 14 Apr 2016 00:46:21 -0400

You can check with the Orthopedic Clinic where you are seen. Some of them will make molds then have inserts made for you.

Response by CPT Tamara Brewer made Apr 14 at 2016 12:59 AM

CPT Tamara Brewer — Thu, 14 Apr 2016 00:59:44 -0400

VA will pay for that. They did for me.

Response by LCDR Rabbah Rona Matlow made Apr 14 at 2016 1:06 PM

LCDR Rabbah Rona Matlow — Thu, 14 Apr 2016 13:06:52 -0400

Go to the VA, see your PCP and get a referral to Podiatry or OT, they will make any orthotics you need...

Response by SFC Everett Oliver made Apr 14 at 2016 1:46 PM

SFC Everett Oliver — Thu, 14 Apr 2016 13:46:08 -0400

Many of you just don't understand. A retiree shouldn't have to go to the VA for treatment that should be covered. Why should I have to go see a doctor whom I do not know, wait 6 months for an appointment and take an appointment from some other veteran who has no other doctor? I have a family doctor and a Podiatrist whom my wife and I have seen for 15 years, why shouldn't this be covered?

Response by Lt Col Jim Coe made Apr 14 at 2016 2:21 PM

Lt Col Jim Coe — Thu, 14 Apr 2016 14:21:18 -0400

See a surgeon (MD or DO) specializing in foot and ankle surgery. He or she can prescribe orthopedic inserts and shoes. Take prescription to a company that makes custom medical devices, such as artificial limbs. They will make the inserts and order shoes. Medicare and Tricare will cover it all. They did for me.

Response by CMSgt Private RallyPoint Member made Apr 14 at 2016 9:48 PM

CMSgt Private RallyPoint Member — Thu, 14 Apr 2016 21:48:21 -0400

As a retiree I with Tricare Standard I got the same answer. On the phone they told me you can get them once a year, but believe that's for diabetes. Mine were denied.

Response by SFC Boots Attaway made Apr 19 at 2016 8:49 PM

SFC Boots Attaway — Tue, 19 Apr 2016 20:49:54 -0400

Sorry to say but you may have to go to the (ugh) VA.

Response by SGM Robin Johnson made Apr 21 at 2016 2:21 AM

SGM Robin Johnson — Thu, 21 Apr 2016 02:21:11 -0400

For inserts and orthotics the official rules can be a little confusing (especially since military hospitals are a little more flexible about making them.) I will put the official rules right after this, along with information about how to find out the covered benefits for all TRICARE beneficiaries, and your TRICARE for Life benefits.

But bottom line up front, if your doctor states that the medical necessity for inserts is to improve the function of a body part that moves (such as reducing pain in your hip or knee so you can walk, stand, or exercise more easily) you have a much better chance of having it approved.

For this and any other issues, you should call Wisconsin Physician Service (WPS), the TRICARE for Life contractor at [login to see] .
You can also file a complaint/appeal online with the actual TRICARE agency (the military part, not the contractor) at http://tricare.mil/ContactUs/FileComplaint.aspx

So, here are the official coverage rules for inserts and orthotics:

TRICARE covers orthotic devices to protect, support, or improve function of parts of the body that move.
TRICARE covers orthotic braces including shoes, inserts and heel/sole replacements when:
•The shoe is an integral part of a brace,
•Its expense is included as part of the cost of the brace, and
•Neither the shoe or the brace is usable separately.
Exclusions:
•Arch supports and shoe inserts designed to effect conformational change in the foot or foot alignment.
•Orthopedic shoes, unless one or both shoes are an integral part of a covered brace.
•Over-the-counter custom-made or built-up shoes or other supportive devices of the feet such as: wedges, specialized fillers, heel straps, pads, shanks, etc., except where otherwise covered.
•Cranial orthosis and cranial molding helmets for nonsynostotic positional plagiocephaly and when used alone as treatment for craniosynostosis.

If you don't yet have a TRICARE 4U account (the TRICARE for Life beneficiary portal), here is the site to create one, or access it if you have one (if you have your DS Logon (DOD Self Service LogOn) you can just use that
: https://www.tricare4u.com/wps/portal/tdb/tricare4u/home/!ut/p/z1/04_Sj9CPykssy0xPLMnMz0vMAfIjo8ziAzw8zDwMLQx8LAJdDQwczSwMvQINnY0tDMz0wwkpiAJKG-AAjgZA_VFgJUbuBp4eBgaG3gbuIAkjZ1ezkEBfYxcLI6gCPGYU5EYYZDoqKgIAPiEonQ!!/dz/d5/L2dBISEvZ0FBIS9nQSEh/

From there you can look up information about how Medicare and TRICARE for Life work together to pay for your care.
To see what TRICARE covers (for all plans) you can go to: http://www.tricare.mil/CoveredServices/IsItCovered.aspx

I hope this helps!

You can file an appeal when you don't agree with a decision made about your benefit. The appeal process is different based on the benefit issue. Depending on your issue, you can file a:

Response by SSG Richard Reilly made Apr 21 at 2016 11:49 AM

SSG Richard Reilly — Thu, 21 Apr 2016 11:49:20 -0400

If you are retired go on base a lot of them can make them on the spot for you.

Response by CW5 Private RallyPoint Member made Apr 26 at 2016 9:27 AM

CW5 Private RallyPoint Member — Tue, 26 Apr 2016 09:27:14 -0400

See an orthopedic MD.

Response by PO2 Mike Vignapiano made Apr 26 at 2016 5:55 PM

PO2 Mike Vignapiano — Tue, 26 Apr 2016 17:55:32 -0400

Seeing your issue, I called my Dr at the VA outpatient clinic I go to. He suggest you go to a Podiatrist at a VA facility. If you don't want it done there, as long as s/he writes it up as necessary, he "believes" Tricare must cover it. But of course, a call to Tricare should confirm this.

Response by MSG Clifton Stillwell made May 5 at 2016 12:16 AM

MSG Clifton Stillwell — Thu, 05 May 2016 00:16:17 -0400

Go to the VA and get them made.

Response by CPO Joel Siruno made May 13 at 2016 9:10 PM

CPO Joel Siruno — Fri, 13 May 2016 21:10:27 -0400

I go through VA. Dr submits a civilian referral, gets approved, and a list of approved places. I have been doing
this for three years. I use Hanger clinic. It makes an impress of my feet. I get two custom soles and two pairs of shoes every year.

Response by CWO2 MaX Craft made Jul 6 at 2021 6:20 PM

CWO2 MaX Craft — Tue, 06 Jul 2021 18:20:51 -0400

The VA sent me to an outside Podiatrist and they made me inserts for both feet. I’m at 50% disabled. Maybe talk to the patient representative at the VA

Response by SFC Randy Hellenbrand made Nov 6 at 2021 9:47 AM

SFC Randy Hellenbrand — Sat, 06 Nov 2021 09:47:14 -0400

TRUMP. HE IS THE BONESPUR EXPERT!!!!!!!!!!!!!!!!! And FYI, Bonespurs are for LIFE!!!! Except on the golf course it seems.

Go to your VA doctor to start with. If all else fails, ask your senator for help.