One of the more common questions we receive at our office, especially with regard to diabetes, is “What qualifies for diabetic foot care?” We provide diabetic foot services that include nail care, callus care, and diabetic shoes. It’s not always clear, though, as to what qualifies someone to have these services covered. Let’s take a look at this matter today so you will have a better understanding of your options.
Many believe that having diabetes qualifies a person to receive diabetic foot care coverage from Medicare and Medicaid. Sure, the disease itself will get you to the door, but if you want to go in, there needs to be more to actually open it up.
People are surprised to learn what the qualifiers for diabetic foot care coverage is the presence of risk factors that increase the risk for dangerous complications (including potential limb amputation). These high-risk qualifiers include peripheral neuropathy, peripheral arterial disease (PAD), and deformities. It is bad news to have just 1 of these problems but if there is a silver lining it’s being 1 step closer to covered care. Trust me, you REALLY don’t want to be in this category.
When combined, nerve damage, poor circulation, and impaired immune function from the diabetes prevent the body from detecting as well as healing problems. This means the risk of eventually needing an amputation becomes elevated. It would be nice to think that the government is concerned about our health and well-being, but they are trying to spend as little money as possible. They know that $1 of prevention can save $60-$70 down the road if they avoid a non-traumatic amputation.
An important tool for any diabetic individual to stay safe is proper footwear. If the appropriate risk factors are present, diabetic shoes are covered. This is determined on a case-by-case basis, so we will need to meet to determine if it applies to you.
The reason diabetic footwear is so in demand is the simple fact they work. It’s true that diabetic shoes aren’t always the most fashionable, but they are certainly functional. A good pair of diabetic shoes will reduce your risk of complications by over 40%. Now, if you go back to wearing normal shoes and ditch your preventative care measures, the simple fact remains that your risk will shoot right back up. Prevention measures must be maintained in order to be effective.
In addition to the qualifying factors, there’s actually a little bit more—the conditions must be properly documented in the chart by your primary care physician or the physician managing your diabetes within the prior 6 months. On our end, we document everything carefully. There may be other doctors who interpret the rules do things differently (loosely), but our policy is to follow the letter of the law because it happens to be a law. As a result of so many rules, 30% of the suppliers of diabetic shoes have stopped this service.
Speaking of the law, some people come from other areas of the country and say “but my doctor back in Florida covered this. Well, it’s possible the doctor was following the law as it applies in their region. We have to abide by the ones that govern our practice.
For more information, or to schedule an appointment to see if you might qualify for diabetic foot care services, simply give us a call at (317) 545-0505 or connect with our Indianapolis office online today.