Funding
Assistive Devices Program
Through the Assistive Devices Program (ADP), the Ontario government helps people with long-term physical disabilities pay for custom orthopedic devices and braces. Only Certified Orthotists are allowed to bill ADP for the provision of Orthotic devices.
To qualify, you must
- be an Ontario resident
- have a valid Ontario health card
- have a disability requiring the equipment or supplies for six months or longer
ADP does not consider your income when assessing eligibility.
You do not qualify for the ADP if you:
- already qualify for or are receiving financial support for the same equipment or supplies from the Workplace Safety and Insurance Board (WSIB)
- are a Group “A” veteran and already qualify for or are receiving financial support from Veterans Affairs Canada for the same equipment or supplies
As Certified Orthotists our clinicians serve as both a registered Authorizer and Vendor and will assess your requirements on a case-by-case basis. Please Contact Us to organize an assessment appointment. We will also require your Physician to sign the ADP application.
ADP covers 75% of the cost for approved orthopedic devices. For these items, the portion paid by ADP is paid directly to us and you pay the remaining 25% when you receive the item.
ADP does not cover some types of orthopedic devices and braces such as
- arch supports or foot orthoses
- fracture braces
- nighttime-use-only orthoses
- orthopedic shoes (even those custom-made) and modifications
- stockings for varicose veins or venous insufficiency
- treatment machines, such as transcutaneous electrical nerve stimulation (TENS) or continuous passive motion (CPM)
ADP does not cover repair costs. You must pay those costs yourself. Care and maintenance of the equipment is your responsibility. You are eligible to receive a new device/devices every 2 years starting from the date that you were initially fit with your orthopedic device.
If you are in receipt of the Ontario Disability Support Program (ODSP), the Assistance for Children with Severe Disabilities (ACSD), or Ontario Works (OW), you will likely qualify for 100% coverage from ADP.
Non-Insured Health Benefits Program
The Non-Insured Health Benefits (NIHB) Program is a national program that provides coverage to registered First Nations and recognized Inuit for a specified range of medically necessary items and services that are not covered by other plans and programs. Only Certified Orthotists are allowed to bill NIHB for the provision of orthotic devices.
Most orthotic devices are covered by the NIHB program for those who meet NIHB’s eligibility requirements. For a comprehensive list of devices, please Click Here.
Workplace Safety & Insurance Board
WSIB provides coverage when there has been a workplace injury requiring an orthotic device as part of the treatment. Clinical Orthotic Consultants can directly bill WSIB in most cases once coverage for the prescribed device has been approved.
Each case is different when dealing with WSIB. Typically, WSIB will require an initial assessment appointment to formulate a treatment plan. Once we have assessed your individual needs and submitted our quote to WSIB, they will determine if coverage is given.
Green Shield Canada
Green Shield Canada covers a variety of medical devices including orthotic devices. Clinical Orthotic Consultants is able to bill Green Shield directly in most cases.
Your individual plan with GSC will determine what items are covered and at what rate they are covered. We advise that you contact GSC prior to proceeding if you are unsure of your coverage to find out what is covered.
GSC in Ontario is familiar with how ADP works and will co-ordinate your benefits with that in mind. If you are covered for the device, they will typically cover the portion that is not paid by the ADP program at the rate defined by your coverage plan.
In some cases GSC will cover only a certain percentage of the whole cost of an orthotic device or you may have a deductible amount that must be paid. In such cases, payment will be required on the date that we fit the device.
Other Insurers
Clinical Orthotic Consultants is experienced in dealing with many different insurance companies and while we typically are not allowed to direct bill with insurers other than those listed in the other sections on this page, we can provide all required documentation for you to submit your claim. Please contact us for more information on the documents we can provide or to book your assessment appointment today.