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Aetna Plans

Routine foot care is not covered under most of Aetna plans.  Please check benefit plan descriptions for details.  Under plans that exclude routine foot care, foot care is considered non-routine and covered only in the following circumstances when medically necessary:

  • The non-professional performance of the service would be hazardous for the member because of an underlying condition or disease; or
  • Routine foot care is performed as a necessary and integral part of an otherwise covered service (e.g., debriding of a nail to expose a subungual ulcer, or treatment of warts); or
  • Debridement of mycotic nails is undertaken when the mycosis/dystrophy of the toenail is causing secondary infection and/or pain, which results or would result in marked limitation of ambulation and require the professional skills of a provider.

Routine foot care includes, but is not limited to, the treatment of bunions (except capsular or bone surgery thereof), calluses, clavus, corns, hyperkeratosis and keratotic lesions, keratoderma, nails (except surgery for ingrown nails), plantar keratosis, tyloma or tylomata, and tylosis.  The reduction of nails, including the trimming of nails, is also considered routine foot care.

Treatment of these conditions may pose a hazard when performed by a non-professional person on individuals with a systemic condition that has resulted in severe circulatory embarrassment or areas of desensitization in the legs or feet.  Some of the underlying conditions that may justify coverage of foot care that would otherwise be considered routine include arteriosclerosis, chronic thrombophlebitis, diabetes, and peripheral neuropathies.

For plans that do not exclude routine foot care, Aetna does not consider pedicure services, such as routine cutting of nails, in the absence of disease of nails, as treatment of disease.  Please check benefit plan descriptions for details.

Background

The Medicare program also generally does not cover routine foot care.  Medicare assumes that patients or their caregivers will perform these services by themselves.  Medicare has interpreted routine foot care to include, among other things, any foot care services performed in the absence of localized illness, injury or symptoms involving the foot.  Aetna’s HMO policy is similar to Medicare policy on routine foot care, in that Medicare also does not cover: cutting or removal of corns and calluses; clipping or trimming of normal or mycotic nails; shaving, paring, cutting or removal of keratoma, tyloma, and heloma; non-definitive simple, palliative treatments like shaving or paring of plantar warts which do not require thermal or chemical cautery and curettage; and other hygienic and preventive maintenance care in the realm of self care, such as cleaning and soaking the feet and the use of skin creams to maintain skin tone of both ambulatory and bedridden patients.  Exceptions to this exclusion apply for persons with a systemic condition such as metabolic, neurologic, or peripheral vascular disease resulting in circulatory deficits or areas of decreased sensation in the individual’s legs or feet, such that the performance of routine foot care by a non-professional person may pose a hazard. Cited www.aetna.com

A visit to a podiatrist is a benefit covered by most insurance plans. However, there can be restrictions due to changes in recent health care coverages.

To avoid any additional cost to the patient, Podiatry Group of Georgia will work with your insurance company to get your services covered. Sometimes this requires our office to send in a letter of medical necessity which will state the reasoning behind the recommended treatment and include the patient’s history and diagnosis.

As a courtesy to our patients, we will contact your insurance company prior to your visit to verify that services are covered and that no referrals are required. This allows us to provide you with the best care while making sure you are aware of your insurance benefits for any treatments or services recommended for your specific condition before they are performed.

If you are having any foot pain, or overall concerns with your feet and want to schedule an appointment, please contact our office at (404) 806-3731. We will be able to help to you with any of your insurance concerns. Your insurance company will also be able to review your plan with you prior to your visit.

Seeking Treatment

If you’ve been searching for Foot Doctor for all your foot and ankle needs, take time to meet with the Podiatry Group of Georgia. Our doctor has the experience and knowledge you need to help your feet and ankles feel their best. Give us a call today and set up an appointment for your initial consultation. Call us today

Call Our Marietta, Georgia Office Today at 404-806-3731 or Book your appointment online now!

Serving Marietta And Atlanta Area!

 

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Aetna
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Aetna
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Routine foot care is not covered under most of Aetna plans.  Please check benefit plan descriptions for details. Read More Now !
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Marietta GA 30062

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