The Motocross Knee Braces Covered by Insurance and How to Claim.

The Motocross Knee Braces Covered by Insurance.

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Summary

The ‘off the shelf’ motocross knee braces that are certified as medical devices and can be insured are Leatt, Mobius and POD.

To claim insurance for knee braces follow these steps –

1. Check that your insurance plan covers you for Healthcare Common Procedure Coding System (HSPSC code L1845)

2. See your doctor and convince them that you need knee braces and your choice of braces is the best for your needs.

 DO NOT TELL THE INSURANCE COMPANY YOU NEED THEM FOR DIRT BIKE RIDING! MAKE SURE THE DOCTOR DOESN’T WRITE THIS IN THE NOTES.

3. Send medical records and doctor’s prescription off to your insurance company.

4. Wait for pre-authorization which includes the details of the claim including any co-payments required.

5.  Once you get approval, buy your preferred knee braces and send the invoice off to your insurance company for the cost to be reimbursed.

 A quick disclaimer.. the information I’m providing in this blog must not in any way be used as advice and you must seek professional insurance advice if you need specific answers.


So you want to get insurance to cover the cost of your knee braces?

It is possible to do but there are a few steps that you will need to complete first.

in this article, I will show you which knee braces can be claimed under insurance and I will show you the steps that you will need to take to be successful.

The Motocross Knee Braces Covered by Insurance.

There are 2 types of knee braces available in the market that are insurable.

The first is the off the shelf (OTS) knee braces such as Leatt, Mobius etc.

These knee braces came in standard sizes are ready to go straight out of the box.

The second type are custom built and fitted knee braces, such as CTi.

The custom built knee braces contain all the safety features of the OTS braces but the difference is that they are tailor made specifically for your legs and knees.

Currently, the ‘off the shelf’ (OTS) knee braces that are certified as a medical device and claimable on insurance are the following –

*Models may change so don’t use this list as gospel. Do your own research! 

MODELPRICEInsurance Approved?
Leatt X-Frame$450YES
Leatt C-Frame$500YES
Mobius X8$600YES
POD MX K8 2.0$800YES
POD MX K8$600YES
POD MX K4$500YES
Asterisk Ultra Cell 2.0$750 NO
Asterisk Ultra Cell$750NO
Asterisk Cell$665NO
EVS Axis Pro$625NO
Alpinestars Fluid Tech Carbon$740NO
Alpinestars Fluid Pro$450NO

 

Now, I’m not saying that the knee braces that haven’t been medically certified offer less protection!  In fact these premium models all offer equal levels of protection for your knees and legs.

The difference is that companies like Leatt and Mobius spent extra time, money and testing to get through the legal process of getting them medically certified from the appropriate medical authorities.

The Details and Disclaimer

The above noted OTS knee braces are approved by insurance companies as a ‘post injury device’ only.This means that they are only covered by insurance if you already have a knee injury.

But as I’ve stated in previous articles about knee braces, don’t wait until you get a knee injury before getting braces! because prevention is a lot better than cure.

 If you think that knee braces are too expensive, investigate the cost of knee surgeries and you will find that the costs of knee braces are nothing in comparison.

 This blog is a guide only based on what I have done in the past. Please be aware that insurance companies and the medical system change up their shit regularly and things may be a bit different when you try to claim.

#1 Check with your Insurance to Make Sure you are Covered for Knee Braces.

The insurance system in the USA contains a coding system called HCPCS (Healthcare Common Procedure Coding System) to identify healthcare items.

What you are looking for is the following –

 CODE FOR KNEES (2018) L1845 – Knee orthosis, double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated item that has been trimmed, bent molded, assembled, or otherwise customized to fit a specific patient by and individual with expertise.

 Give your insurance company a call and ask them if you are covered for that code. If you aren’t, then it’s time to upgrade your plan or switch insurance companies if you want to claim your knee braces.

If you are covered, ask them for an insurance application and take it with you to see your doctor.

#2 Convince your Doctor that you need Knee Braces.

You have to assume that your doctor knows nothing about knee braces so it will be up to you to educate your doctor.

You will need to explain to your doctor that you are a dirt bike enthusiast and will need knee braces specifically for dirt bike riding.

This will help your doctor see that knee braces are the best in the industry and they suit you the best.

If your doctor doesn’t get it, try to find another doctor that specialize in knee injuries from dirt bike riding. They will most likely know all about knee braces for dirt bike riders.

Once your doctor decides that you need knee braces, get them to write you out a prescription for your chosen knee braces and also get a copy of your medical records for insurance.

 Its important that you do not tell the insurance company that you need knee braces for dirt bike riding. Instead get the doctor to write the notes without mentioning anything about motocross. Insurance companies don’t like dirt bikes much. 

#3 Send Information to your Insurance Company.

Send off the following to your insurance company –

1. Doctor’s prescription
2. Medical records
3. Medical release form
4. Insurance application
5. Insurance card

#4 Wait for pre-authorization.

Once you have sent off all the documents to your insurance company you will need to wait for pre-authorization.

After you have received pre-authorization, you will receive all the details of the insurance claim and if there are any co-payments that need to be covered by you.

#5 Get Approval.

If all goes to plan, you will receive approval from your insurance company.

If you are buying off the shelf knee braces, approval means that you can purchase the braces of your choice (that are classed as a medical device) from a dirt bike store.

If you are getting custom knee braces such as CTi, you can now visit the clinic and be measured up to have your knee braces built.

Once you have purchased, just send the invoice off to your insurance company and you are done!

 When you receive your invoice, be sure that they include the HCPCS code L1845 on the invoice. This is so insurance can match the code with the item and process your claim quickly.

Conclusion

Have you ever claimed insurance for your knee braces? Let us know in the comments box below and let me know what the main obstacles were.

 

Next article –

>> Motocross Insurance. How to get the right healthcare plan for dirt bike riding.

Happy Riding!

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Amanda
Amanda
1 year ago

I work for an Orthotics & Prosthetics Company (We are the ones who fit and provide these braces) and my job is to ensure items are covered by insurance. The above information is not entirely correct. First, no insurance company is going to cover a brace that is only medically necessary during an extracurricular activity. It must be medically necessary for all ADL’s (activities of daily living). So, with that said, the coverage criteria for most insurance companies are the same for these types of braces. 1. Must have a chart note from your doctor that documents a knee instability.… Read more »

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