Diagnosis: foot pain
Treatment: custom molded orthotics
The insurer denied custom molded orthotics. The health plan's determination is upheld.

The patient is a male who was seen for sore feet. The patient had previous custom molded orthotics that feel weak and are falling apart. On exam, the patient shows hyperpronation of his feet b/l (bilateral). Pain in heels and arch is noted. The patient was diagnosed with plantar fasciitis, calcaneovalgus deformity, and pronation of his feet. He was recommended for custom molded orthotics.

The requested custom shoe inserts are not medically necessary for this patient. There is no documentation of any conservative measures tried such as adjustment of activities, anti-inflammatory meds, stretching tried before recommending custom molded orthotics. Thus, the custom shoe inserts are not medically necessary.