Board Certified Podiatrists | Expert Foot & Ankle Care
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Insurance & Podiatry Costs in Michigan | Balance Foot & Ankle

Dr. Tom Biernacki, Dr. Daria Gutkin, and Dr. Carl Jay — board-certified podiatrists at Balance Foot & Ankle, Howell & Bloomfield Hills MI

Insurance & Costs · Howell & Bloomfield Hills

Does insurance cover podiatry in Michigan?

Most medically necessary foot and ankle care is covered. We verify your benefits before your visit and tell you exactly what to expect out of pocket — so there are no surprises.

Free, no-surprise benefit check

Before any treatment, our team confirms exactly what your plan covers and gives you a clear out-of-pocket estimate. Bring your insurance card and a photo ID to your first visit — we handle the rest.

No insurance? Ask about our self-pay rates when you call (810) 206-1402.

Insurance plans we accept

We are in-network with most major insurance plans across Michigan. Don’t see your plan? Call (810) 206-1402 — we likely accept it, and we’ll verify your coverage before your visit.

Blue Cross Blue Shield of Michigan (BCBS)
Blue Care Network (BCN)
Medicare
Medicaid / Meridian
Aetna
United Healthcare
Cigna
Priority Health
HAP (Health Alliance Plan)
McLaren Health Plan
Humana
Molina Healthcare
Tricare / Veterans

What you’ll typically pay

Because we are in-network with most plans, most patients pay only their plan’s standard specialist copay for an office visit — not the full self-pay rate. Your exact cost comes down to three things: your copay and deductible, whether the care is medically necessary, and the type of service. Here’s how the most common services are billed:

What determines your out-of-pocket cost

FACTOR 1
Your copay & deductible
What your plan asks you to pay — and whether your deductible is met yet.
FACTOR 2
Whether it’s medically necessary
Care that treats a medical problem is covered; purely cosmetic care isn’t.
FACTOR 3
The type of service
A visit, an in-office procedure, orthotics, or surgery are each billed differently.
Office visit

Standard specialist copay

A routine evaluation is billed like any specialist visit. If your deductible is met you may owe only a small copay; if not, you may owe more until it is.

In-office procedure

Copay + possible deductible

Procedures such as ingrown toenail removal or wart treatment are usually covered when medically necessary, billed separately from the visit.

Custom orthotics

Plan-dependent

Some plans cover custom orthotics fully, some partially, some not at all. We verify your specific benefit and quote you first.

Diabetic shoes

Often covered by Medicare

Qualifying diabetic patients are frequently eligible for therapeutic shoes once per year under Medicare’s benefit.

Surgery

Copay, deductible & coinsurance

Medically necessary surgery (e.g., bunion correction) is covered by most plans. We provide a written estimate before scheduling.

FSA / HSA

Eligible for most care

Visits, orthotics, and many recommended products can be paid pre-tax with your FSA or HSA.

Whatever your situation, we confirm your benefits and give you a clear out-of-pocket estimate before any treatment begins.

What to expect at your first visit

A quick walkthrough of how your first appointment works — from check-in and benefit verification to getting a clear diagnosis and plan before you leave.

1
Check in & verify benefits
2
Exam & diagnosis
3
Clear treatment plan
4
Estimate before treatment
New Patient Visit Michigan Podiatrist | What to Expect

New patient visit at Balance Foot & Ankle — what to expect | Dr. Tom Biernacki, DPM

What “medically necessary” means for coverage

Insurance almost always covers foot and ankle care that treats a medical problem. If you have any symptom — pain, a fungal or thickened nail, a painful callus, an infection, or trouble cutting your own nails — that’s a medical visit, and it’s generally covered. The only thing insurance won’t cover is purely cosmetic care on healthy feet with no symptoms. Not sure which applies to you? A visit is always appropriate — come in and we’ll make the determination with you during your appointment, before you’re billed.

✓ Generally covered

  • Pain, injury, or fractures
  • Fungal, thickened, ingrown, or painful nails
  • Thick or hard-to-cut toenails when you’re older or have a health condition (diabetes, poor circulation, etc.)
  • Painful calluses or corns
  • Infections (including ingrown or fungal nails causing problems)
  • Diabetic foot care and at-risk feet
  • Warts, ulcers, and wound care
  • Bunions, hammertoes, and other deformities causing symptoms
  • Nerve pain and neuropathy

✗ Usually not covered

  • Cosmetic nail trimming on healthy nails — no fungus, no pain, no thickening, and no trouble cutting them yourself
  • Purely cosmetic skin or nail requests with no medical problem
  • Comfort-only orthotics with no medical diagnosis (plan-dependent)
  • Care explicitly excluded by your specific plan

Think something’s wrong? That’s a covered visit.

If you think you may have a medical issue — fungus, a painful or thickened nail, a callus that hurts, or nails you can’t safely trim yourself — that’s a covered medical visit. A visit is always appropriate when you need one. You don’t have to diagnose yourself first — we make the coverage determination with you during the appointment.

Insurance & cost FAQ

Do you verify my benefits before my visit?

Yes. Our team confirms exactly what your plan covers and gives you a clear out-of-pocket estimate before any treatment begins. Just bring your insurance card and a photo ID to your first visit.

What will I pay at my first appointment?

Most patients pay only their plan’s standard specialist copay for an office visit. If your deductible isn’t met yet, you may owe more until it is. We tell you what to expect ahead of time so there are no surprises.

What if you’re not in-network with my plan?

We’re in-network with most major Michigan plans, and we likely accept yours even if it isn’t listed. Call (810) 206-1402 and we’ll verify your coverage before your visit.

Is bunion or foot surgery covered?

Medically necessary surgery is covered by most plans. Your cost depends on your copay, deductible, and coinsurance — we provide a written estimate before anything is scheduled. See our bunion surgery coverage guide.

Does Medicare cover diabetic shoes?

Qualifying diabetic patients are often eligible for therapeutic shoes once per year under Medicare. We confirm your eligibility first — read more in our diabetic shoes guide.

Can I use my FSA or HSA?

Yes — many foot-care visits, custom orthotics, and recommended products are FSA/HSA eligible and can be paid for pre-tax.

Do I need a referral to see a podiatrist?

It depends on your plan. Most PPO plans let you see a podiatrist directly. Some HMO and Medicare Advantage plans require a referral from your primary care doctor first. When we verify your benefits before your visit, we’ll tell you whether a referral is needed and help you get one.

Does my treatment need prior authorization?

A routine office visit almost never does. Certain services — advanced imaging (MRI), some custom orthotics or durable medical equipment, and most surgeries — may. We handle that paperwork and won’t schedule those services until any required authorization is approved, so you’re never left with an unexpected bill.

Could I get a “surprise” out-of-network bill?

For most patients, no — we’re in-network with most major Michigan plans. You’re also protected by law: the federal No Surprises Act and Michigan’s surprise-billing law (PA 234 of 2020) shield you from unexpected out-of-network charges in many situations. On top of that, we verify your benefits and give you a clear estimate before treatment.

Is routine nail and callus care covered?

Often, yes. When thick, painful, fungal, or hard-to-trim nails — or painful calluses — are tied to a medical condition such as diabetes, poor circulation, or neuropathy, Medicare and most insurers cover this care (generally about every 60 days). Purely cosmetic trimming of healthy nails isn’t covered. If you’re unsure, just come in — we’ll determine what applies to you. See our toenail care and diabetic foot care pages.

Does Medicare cover custom orthotics?

Original Medicare generally doesn’t cover custom orthotics for most conditions, though it does cover therapeutic shoes and inserts for qualifying diabetic patients. Many commercial plans cover orthotics fully or partially. We verify your specific benefit and quote you before you order — and if coverage is limited, we’ll do our best to get your custom orthotics covered, let you know ahead of time, and never gouge you when there’s a coverage gap. See our custom orthotics coverage guide.

How does Medicare Advantage work for podiatry?

Medicare Advantage (Part C) plans cover the same medically necessary foot and ankle care as Original Medicare, but they use their own networks and may require referrals or prior authorization. We verify your specific plan’s rules before your visit so there are no surprises.

What if I can’t pay my balance all at once?

Talk to us — we don’t want cost to keep you from getting care. Ask about our self-pay rates and payment options when you call (810) 206-1402 and we’ll walk you through what’s available.

Does insurance cover a second opinion?

Usually, yes. Most plans cover a second opinion for a medically necessary diagnosis or before surgery. We’ll verify your benefit and request any records needed — bring your imaging or reports if you have them.

What should I bring to verify my coverage?

Bring your insurance card (plus a secondary card if you have one), a photo ID, a referral if your plan requires one, and a list of your current medications. That’s all we need to confirm your benefits and give you an accurate out-of-pocket estimate.

Are procedures like ingrown toenail, wart, or fungus treatment covered?

Yes — when they treat a medical problem, these are covered by most plans and billed like any in-office procedure (your copay, plus deductible if it isn’t met). We confirm your benefit first. See our guides on ingrown toenail removal, plantar wart removal, and toenail fungus treatment.

What if I don’t have insurance?

We offer self-pay rates. Ask about them when you call (810) 206-1402 and we’ll walk you through your options.

See a podiatrist in Howell or Bloomfield Hills

Not sure what you need or what it’ll cost? We can help you choose — and verify your benefits before you come in.

Our offices

Howell

4330 E Grand River Ave
Howell, MI 48843
(810) 206-1402
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Serving Howell, Brighton, Hartland, Fowlerville, Pinckney, Fenton & all of Livingston County.

Bloomfield Hills

43494 Woodward Ave #208
Bloomfield Hills, MI 48302
(810) 206-1402
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Serving Bloomfield Hills, Birmingham, Troy, West Bloomfield, Farmington Hills, Royal Oak & Oakland County.

Balance Foot & Ankle surgeons are affiliated with Trinity Health Michigan, Corewell Health, and Henry Ford Health — three of Michigan’s largest health systems.

Medically reviewed by Dr. Tom Biernacki, DPM.



Balance Foot & Ankle surgeons are affiliated with Trinity Health Michigan, Corewell Health, and Henry Ford Health — three of Michigan’s largest health systems.