Blue Cross Blue Shield Podiatrist Michigan: What BCBS Covers

Quick answer: Yes — Blue Cross Blue Shield of Michigan and Blue Care Network cover medically necessary podiatry: office visits, diagnostic imaging (X-ray, ultrasound), most foot and ankle surgery, and diabetic foot care. Routine cosmetic nail care is excluded. Balance Foot & Ankle is in-network with most BCBS plans and verifies your exact benefits for free before your visit — call (810) 206-1402.

Medically reviewed by Dr. Tom Biernacki, DPM, FACFAS

Board-certified foot & ankle surgeon · Balance Foot & Ankle

Last reviewed July 2026 · (810) 206-1402

Does Balance Foot & Ankle accept Blue Cross Blue Shield?

Yes. Balance Foot & Ankle is in-network with most major insurance plans in Michigan, including Blue Cross Blue Shield of Michigan (BCBS) and Blue Care Network (BCN). Whether you are looking for a podiatrist that takes Blue Cross Blue Shield of Michigan or comparing podiatrists that accept Blue Cross Blue Shield near you, you can be seen at either of our offices — Howell in Livingston County, or Bloomfield Township in Oakland County.

Plan details vary from one policy to the next, so our team runs a free, no-surprise benefit check before any treatment and confirms exactly what your plan covers. Book online or call (810) 206-1402 to verify your coverage, or use the appointment form at the bottom of this page.

Does Blue Cross Blue Shield cover podiatry in Michigan?

Yes — Blue Cross Blue Shield of Michigan and Blue Care Network cover podiatric services when they are medically necessary. This includes in-office visits for diagnosis and treatment of foot and ankle conditions, diagnostic imaging (X-rays, ultrasound), most surgical procedures, and preventive diabetic foot care for qualifying members. What’s covered, at what cost-sharing level, depends on your specific plan tier and deductible status.

At Balance Foot & Ankle, we work with most BCBS plans including BCBS Blue Care Network (BCN), BCBS Commercial PPO plans, BCBS Medicare Advantage, and Federal Employee Program (BCBS FEP). We verify insurance coverage prior to appointments and provide patients with estimated out-of-pocket costs upfront whenever possible.

What BCBS typically covers for podiatry

The following services are generally covered by BCBS plans when medically necessary documentation criteria are met. Specific coverage varies by plan — the percentages and copays below reflect typical ranges, not guarantees.

Office visits and evaluations

New patient and established patient office visits for medically necessary foot and ankle conditions are covered under standard evaluation and management (E&M) codes. Most BCBS plans apply a specialist copay of $30–$60 per visit after deductible. Routine foot care (nail trimming, callus reduction without systemic disease) is specifically excluded from coverage under most plans — this is a standard CMS-derived exclusion, not specific to BCBS.

Diabetic foot care — expanded coverage

Patients with diabetes receive expanded podiatric coverage under BCBS plans. Medicare-based BCBS plans cover one preventive diabetic foot exam per 6-month period when peripheral neuropathy or PAD is documented. Therapeutic footwear (one pair of shoes and two pairs of custom insoles annually) is covered under the Medicare Therapeutic Shoe Program for qualifying diabetic patients. Non-routine foot care (callus reduction, nail care) that is typically excluded becomes covered when performed for diabetic patients with qualifying comorbidities.

Custom orthotics

Custom foot orthotics are among the most commonly coverage-denied podiatric services, and understanding the specific criteria for BCBS coverage prevents costly surprises. BCBS generally covers custom orthotics when: a biomechanical examination documents a qualifying condition (rearfoot valgus/varus, forefoot deformity, leg-length discrepancy), the orthotic is required for treatment of a covered diagnosis (not “comfort” or “prevention”), conservative treatment without orthotics has been attempted and documented, and the ordering provider is credentialed for orthotic prescribing. Over-the-counter insoles and “arch supports” are never covered as durable medical equipment — custom orthotics fabricated from a cast, scan, or foam impression are required.

Surgical procedures

Medically necessary foot and ankle surgery is covered by BCBS subject to your plan’s deductible, coinsurance, and out-of-pocket maximum. Most elective foot surgeries (bunion correction, hammertoe repair, plantar fascia release, ankle arthroscopy) are covered when preceded by documented failed conservative treatment meeting plan criteria. Pre-authorization is required for most surgical procedures. Emergency or urgent surgeries (infections, fractures, tendon ruptures) are covered without prior authorization.

What BCBS does NOT cover for podiatry

Knowing coverage exclusions prevents billing surprises as much as knowing what’s included. Standard BCBS podiatry exclusions include: routine foot care (nail trimming, callus shaving) without a qualifying systemic diagnosis; orthotic shoe modifications beyond medical necessity documentation; cosmetic procedures (nail polish, pedicure-related services); experimental or investigational treatments; and foot care products (creams, pads, braces) except when specifically enumerated as covered DME.

How to verify your BCBS podiatry coverage

The most reliable way to understand your specific coverage is to call the Member Services number on the back of your BCBS card before your first appointment. Ask specifically: Is Balance Foot & Ankle in-network with my plan? What is my specialist copay vs. out-of-pocket cost after deductible? Is my deductible met for this plan year? Are custom orthotics covered, and what documentation is required? What is my coinsurance for surgical procedures?

Our billing team can also perform an eligibility and benefits verification on your behalf before your appointment. Contact our office at (810) 206-1402 and we will verify your BCBS coverage and provide an estimated cost-of-care summary before you arrive.

BCBS Blue Care Network vs. BCBS Commercial: key differences

Blue Care Network (BCN) is an HMO product that generally requires selecting a primary care physician and obtaining referrals for specialist visits. BCBS Commercial PPO plans allow direct access to in-network specialists without referral. If you have BCN, check whether your primary care physician needs to issue a referral before your podiatry appointment — seeing a specialist without a required referral may result in claims denial. BCBS Commercial PPO patients can typically self-refer to any in-network podiatrist in Michigan.

Frequently asked questions

Does BCBS cover plantar fasciitis treatment?

Yes — evaluation and management of plantar fasciitis, diagnostic ultrasound, corticosteroid injections, and custom orthotics (when medical necessity criteria are met) are covered by BCBS for plantar fasciitis. Platelet-rich plasma (PRP) injection is considered experimental by most BCBS plans and is typically not covered.

How do I know if Balance Foot & Ankle is in-network with my BCBS plan?

The most reliable method is to call (810) 206-1402 and our billing team will verify your specific plan. You can also search the BCBS provider directory at bcbsm.com using “Balance Foot and Ankle” or Dr. Tom Biernacki’s name.

What is the cost for a podiatry visit with BCBS if my deductible is not met?

When a deductible has not been met, you are typically responsible for the negotiated rate (contracted in-network fee) for the service rather than the billed charge. For a standard new patient evaluation, this is typically $150–$250 depending on visit complexity and your specific BCBS plan’s fee schedule with our office.

Plan-specific BCBS guides

Blue Cross covers podiatry differently depending on which plan you hold — referral rules in particular vary a lot. These guides go deeper than the summary above:

• Blue Care Network: do you need a referral? — why BCN requires one, how to get it from your PCP, and what BCN covers once you have it. This is the single most common reason a BCN member’s claim gets denied.
• Medicare Plus Blue PPO — how the BCBS Medicare Advantage plan differs from Original Medicare, including out-of-pocket maximum protection.
• State of Michigan employee plans — PPO and BCN options for state workers and retirees, and what each covers for foot and ankle care.
• Blue Care Network costs — typical copays and out-of-pocket ranges.
• Does BCBS cover Achilles tendon repair? — a worked example of how BCBS handles a specific surgical procedure, including pre-authorisation.

Not sure which plan you have? Bring your member ID card to your first visit, or call (810) 206-1402 and we will look it up for you.

Blue Cross Blue Shield of Michigan podiatrists near you — both offices

Balance Foot & Ankle sees Blue Cross Blue Shield of Michigan and Blue Care Network members at two offices. Both are staffed by the same board-certified foot and ankle surgeons, and your BCBS benefits work identically at either location — pick whichever is closer.

Howell — Livingston County

4330 E Grand River Ave, Howell, MI 48843
Phone: (810) 206-1402
Howell office details, directions and providers

Convenient for BCBS members in Howell, Brighton, Fenton, Hartland and Pinckney.

Bloomfield Township — Oakland County

43494 Woodward Ave #208, Bloomfield Township, MI 48302
Phone: (810) 206-1402
Bloomfield office details, directions and providers

Convenient for BCBS members in Bloomfield Township, Birmingham, West Bloomfield and Troy.

Searching for a “Blue Cross Blue Shield of Michigan podiatrist near me”? Book online or call (810) 206-1402 with your member ID and we will confirm your in-network status and estimated cost before you book — at whichever office is closer to you.

The bottom line

Blue Cross Blue Shield covers the vast majority of medically necessary podiatric care in Michigan, and Balance Foot & Ankle is in-network with most BCBS plans. Understanding the specific coverage rules for orthotics, surgery pre-authorization, and routine vs. non-routine foot care prevents billing surprises. Call our office at (810) 206-1402 and our billing team will verify your specific BCBS benefits before your appointment — at no charge. We’re here to help you use the coverage you’ve already paid for.

Sources

1. Blue Cross Blue Shield of Michigan. Member Benefits and Coverage Guidelines. bcbsm.com, 2025.
2. CMS. Medicare Benefit Policy Manual: Chapter 15 — Covered Medical and Other Health Services. 2024.
3. American Podiatric Medical Association. Insurance and Coverage Resources. apma.org, 2025.

Request an appointment with a BCBS podiatrist

Blue Cross Blue Shield of Michigan is among the plans we accept at both Michigan offices. If you would rather know your costs before you come in than after, ask for the free, no-surprise benefit check — we verify the podiatry coverage on your plan and tell you what to expect to pay in advance of your visit.

Book online or call (810) 206-1402 or send the form below, and we will confirm the appointment and your coverage together.

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Dr. Tom Biernacki, DPM

Dr. Tom Biernacki, DPM is a board-certified foot & ankle surgeon (ABFAS & ABPM) at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has made him one of the most-followed foot & ankle educators on YouTube.