Medicare Patients

If you are a diabetic with Medicare Part B benefits and a Medicare supplement, you may be entitled to certain diabetic footwear and diabetic inserts once every calendar year at no cost to you. IN order to qualify, you must be diabetic with at least one of the following conditions:

• history of partial or complete amputation of the foot
• foot deformity
• poor circulation
• history of previous foot ulceration
• history of pre-ulcerative callus peripheral neuropathy with evidence of callus formation

If you meet at least one of the above qualifications, the doctor treating your diabetes must complete the attached form certifying your condition(s). If you have a supplemental insurance there will be no cost to you. If you are not covered under a Medicare supplement plan, you will be billed for 20% of the Medicare allowable amount. If you have not met your yearly deductible, you will be billed for the portion of the deductible that remains. Once you have this form completed and signed by the doctor treating your diabetes, please feel free to stop by and see us.

Medicare Diabetic Shoes

Medicare coverage provides one pair of diabetic shoes and three sets of diabetic shoe inlays per calendar year as medically necessary. Medicare usually covers 80% of the bill. SOME secondary insurance companies may cover part or all of the remaining 20%. With a prescription, we also can file your insurance claim for reimbursement to you.

Please follow the instructions below to have the cost of your shoes/inlays/modifications POSSIBLY covered by Medicare. Failure to follow the instructions will cause Medicare to deny your claim.

BEFORE YOU COME IN TO BE FITTED

1. Go to the physician treating your diabetes and have your feet examined. You must have had an office visit with the physician that treats your diabetes within six months prior to your shoe fitting. The form will expire three months from the date the physician signs it.
2. Have the physician complete the entire certification form for your diabetic shoes/inlays/modifications.
3. The physician must include a copy of the medical records that were used to complete this form.

PLEASE BRING THE FOLLOWING TO WALKWELL SHOES

1. Your completed Statement of Certifying Physician for Therapeutic Shoes form and Prescription for Therapeutic Footwear form. The form will expire three months from the date of the physician’s signature.
2. All of your insurance cards.
3. Photo ID.
4. A copy of your doctor’s medical notes from your last office visit that pertain to your diabetic footwear.

If you do not have all of the above information completed prior to your visit to Walkwell Shoes, we will not be able to process your prescription. If you have any questions, please feel free to call us at (908) 273-7979

Thank you,
Walkwell Shoes