Probracing

Getting Your Custom Knee Brace at Little to No Cost

Who will pay for your custom knee brace?

In the Greater Toronto Area, there are several payment providers that will cover most or all of your custom knee brace cost. Each provider has specific requirements. 

1) Private Insurance Plans / Extended Health Care

2) WSIB (Work Related Injury)

3) ODSP (Ontario Disability Support Program

4) How is Payment Made for my Custom Knee Brace

1) Private Insurance Plans / Extended Health Care

  • examples include: Greenshield, Sunlife, Manulife, Desjardins, Canada life etc.
  • private insurance coverage will vary depending on your plan
  • they often cover between 90% – 100% of the full cost
  • insurance companies require you get pre-approved before purchasing a custom knee brace
  • 2 documents are required by most insurance companies for this pre approval:

1. Doctor Referral: a physician, orthopedic surgeon or sports medicine doctor will need to provide you with a written referral that includes:

a) which knee the custom knee brace is for
b) the recommendation of a custom knee brace for daily use (they will not cover custom knee braces for sports purposes only)
c) a written diagnosis, ie. ACL tear, meniscus tear, osteoarthritis, knee sprain/strain etc.

    • Probracing’s sample referral form can be filled out by your doctor or used as a reference
Custom Knee Brace Doctor Referral

2. Estimate Letter: they will also require an estimate letter as part of their pre-approval process, which breaks down the company, brand, materials and cost

Do You Need a Private Insurance Estimate Letter?
  • There are a few insurance companies that have their own pre-approval process
    • Greenshield insurance has a unique form that needs to be filled out by your doctor instead of a doctors referral
Greenshield Authorization Form for Custom Braces
    • RBC insurance has a unique form that needs to be filled out by your doctor instead of a doctors referral
RBC Authorization Form for Custom Braces
    • Claim Secure insurance has a unique form that needs to be filled out by your doctor and your brace supplier instead of a doctor referral 
Claim Secure Custom Knee Brace Form
  • While private insurance companies have their process for custom knee braces to be covered, if their steps are followed you will always be covered for most or all of the cost

INSURANCE QUESTION OR HELP WITH FORMS?

CONTACT PROBRACING

2) Workplace Safety & Insurance Board (WSIB)

  • you must have injured your knee in a workplace accident and have an active claim made, with a claim number given to you
  • WSIB requires you get pre-approved before you can get a custom knee brace 
  • 2 documents are required by WSIB to pre-approve the cost:

1. Orthopedic Surgeon Referral: it can’t be from just a physician, your orthopedic surgeon will need to provide you with a written referral that includes:

a) which knee the custom knee brace is for
b) the recommendation of a custom knee brace for daily use (they will not cover custom knee braces for sports purposes only)
c) a written diagnosis, ie. ACL tear, meniscus tear, osteoarthritis, knee sprain/strain etc.

    • Probracing’s sample referral form can be filled out by your doctor or used as a reference
Custom Knee Brace Doctor Referral

2. Estimate Letter: WSIB will also require an estimate letter which breaks down the company, brand, materials and costs

Do You Need a WSIB Estimate Letter?

3) Ontario Disability Support Program (ODSP)

  • you must have a ODSP number given to you
  • ODSP requires you get pre-approved before you can get a custom knee brace
  • 2 documents are required by ODSP to pre-approve the cost:

1. Doctor Referral: a physician, orthopedic surgeon or sports medicine doctor will need to provide you with a written referral that includes:

a) which knee the custom knee brace is for
b) the recommendation of a custom knee brace for daily use (they will not cover custom knee braces for sports purposes only)
c) a written diagnosis, ie. ACL tear, meniscus tear, osteoarthritis, knee sprain/strain etc.

    • Probracing’s sample referral form can be filled out by your doctor or used as a reference
Custom Knee Brace Doctor Referral

2. Estimate Letter: ODSP will also require an estimate letter which breaks down the company, brand, materials and costs

Do You Need a ODSP Estimate Letter?

4) How is Payment Made for my Custom Knee Brace

  • most private insurance companies will not pay your custom knee brace provider directly
    • you will have to make payment directly to the provider which can be claimed for reimbursement by sending in your paid receipt
    • Canada life (Great West Life), Greenshield and Blue Cross are some of the few insurance companies that allow direct payment, which Probracing accepts
    • You can contact your insurance company and ask if they allow assignment of benefits or direct payment specifically for custom knee braces
  • WSIB and ODSP can pay Probracing directly
  • Probracing is registered with all payment providers and can accept direct payment if they allow

Contact Probracing & Schedule Fitting