Diagnosis: Bilateral foot pain
Treatment: Custom Shoe Inserts (L3000x2) Pre-service
The insurer denied the Custom Shoe Inserts (L3000x2) Pre-service
The denial is overturned.

The patient is a male. He presented to his foot doctor's office for follow-up for bilateral foot pain. His left foot was worse than his right foot. He had been prescribed icing, stretching, Advil, change in shoes, he had also worn orthotics previously. He was diagnosed with bilateral tibial tendonitis, bilateral plantar fasciitis with flat feet based on his clinical examination. Custom orthotics were recommended.

Yes, the Custom Shoe Inserts (L3000x2) are medically necessary.
The clinical records explained that the patient had tibial tendinitis and plantar fasciitis. The denial letter stated that this device -custom foot orthotics- are typically utilized when conservative care has failed. The clinical records clearly documented that the patient had tried and failed Advil, icing, stretching and shoe modifications. In addition, he had previously worn custom orthotics, and the orthotics had been outgrown one year prior.

All the criteria for using custom orthotics in this case have been met and are in the clinical documents provided by the physician.