Insurance & Podiatry Costs in Michigan | Balance Foot & Ankle

Insurance plans we accept in Michigan

Choose your plan to see exactly what is covered, what a visit typically costs, whether you need a referral, and how to book. If your plan is not listed, we still likely accept it — we take most PPO and POS plans.

Don’t see your plan? We accept most PPO and POS plans and will verify your benefits at no charge — call (810) 206-1402 or book online and we’ll check before your visit.

Blue Cross Blue Shield of Michigan is the plan we are asked about most. For a detailed guide to BCBSM PPO, Blue Care Network and Medicare Advantage podiatry coverage, see our Blue Cross Blue Shield of Michigan podiatry coverage guide.

Find your insurance

Choose your plan to see what podiatry care it covers, typical copays, whether you need a referral, and how to book. Not listed? Book online or call (810) 206-1402 — we likely accept it, and we will verify your benefits free before your visit.

Uninsured or using a high-deductible plan? Our self-pay price list shows what each visit and procedure costs up front, and you are entitled to a written Good Faith Estimate before treatment.

Book an appointment with a podiatrist

Once you have found your plan above, the useful next step is an appointment. An exam identifies what is actually causing the pain and what treatment it needs. Balance Foot & Ankle sees patients at two offices — Howell in Livingston County, and Bloomfield Township in Oakland County.

Book online or call (810) 206-1402 or use the form below and our team will find you an appointment time.

Insurance and cost answers, by topic

These are the questions our front desk gets asked every day. Each one has its own page telling you what your plan covers, what the visit or procedure typically costs, and what to bring.

Not sure which one applies to you? Book an appointment and we will verify your benefits before you are seen — there is no charge for that.

Insurance and billing questions we hear most

Straight answers to the questions patients ask before they book. Still unsure? Book online or call (810) 206-1402 and we will check your plan while you are on the phone.

What Podiatric Services Does Insurance Typically Cover?

Most commercial health insurance plans cover podiatric office visits, diagnostic evaluations, X-rays, and medically necessary treatments at the same benefit level as other specialist visits. Conditions including plantar fasciitis, bunions, hammertoes, ankle sprains, fractures, diabetic foot complications, and toenail disorders are generally covered when documented as medically necessary by your podiatrist.

Surgical procedures performed by board-certified podiatrists are covered by insurance when conservative treatment has been appropriately attempted and documented. Most plans require documentation of failed conservative care — typically 3-6 months of non-surgical treatment — before authorizing surgical intervention. Your podiatrist’s detailed medical records establish this treatment history.

Diagnostic imaging including X-rays, MRI, CT scans, and diagnostic ultrasound ordered by your podiatrist is covered when clinically indicated. In-office X-rays performed during your visit are typically processed as part of the office encounter, while advanced imaging like MRI may require prior authorization depending on your specific plan.

Understanding Prior Authorization Requirements

Many insurance plans require prior authorization for surgical procedures, advanced imaging (MRI, CT), custom orthotics, and certain injection therapies. Prior authorization is a pre-approval process where your insurance company reviews the medical documentation before agreeing to cover the proposed treatment.

The prior authorization process typically takes 3-14 business days depending on the insurance carrier and the complexity of the proposed treatment. Balance Foot & Ankle handles all prior authorization submissions on your behalf, including compilation of medical records, diagnostic reports, and clinical rationale documentation.

Denied prior authorizations can be appealed. First-level appeals involve submitting additional clinical documentation supporting medical necessity. Peer-to-peer reviews allow your podiatrist to discuss the case directly with the insurance company’s medical reviewer. Dr. Biernacki’s office advocates persistently for patients whose medically necessary treatments are initially denied.

Emergency treatments including acute fracture care, wound management, and abscess drainage do not require prior authorization and are covered as emergent services regardless of whether you have seen a podiatrist previously.

Custom Orthotics and Shoe Coverage

Custom orthotic coverage varies significantly between insurance plans. Many commercial plans cover custom orthotic devices when prescribed for documented medical conditions such as plantar fasciitis, posterior tibial tendon dysfunction, or diabetic neuropathy. Coverage typically allows one pair of custom orthotics per year or per two years depending on the plan.

The distinction between custom orthotics and prefabricated insoles is important for insurance purposes. Custom orthotics are fabricated from molds or scans of the individual patient’s feet and are covered as durable medical equipment. Prefabricated over-the-counter insoles, regardless of quality, are not covered by insurance because they are not custom-made.

Documentation requirements for orthotic coverage typically include a prescription from a podiatrist, biomechanical examination findings, diagnosis codes supporting medical necessity, and proof that the device was custom fabricated. Balance Foot & Ankle ensures all required documentation is complete before fabrication to prevent coverage denials.

What Insurance Usually Does Not Cover

Cosmetic foot procedures including elective bunion surgery performed solely for appearance, cosmetic toenail treatments, and aesthetic procedures are generally excluded from insurance coverage. However, if a condition causes pain, functional limitation, or documented difficulty with shoe fitting, the same procedure may qualify as medically necessary and receive coverage.

Experimental or investigational treatments including certain regenerative medicine therapies (PRP, stem cell injections) are not covered by most insurance plans. These treatments may be effective but have not yet achieved the level of evidence required for insurance coverage. Balance Foot & Ankle provides transparent pricing for non-covered services.

Routine foot care without qualifying conditions — nail trimming, callus debridement, and corn removal for healthy patients without diabetes, vascular disease, or other systemic conditions — is typically not covered by insurance. These services are available on a self-pay basis at reasonable rates.

Maximizing Your Podiatric Insurance Benefits

Verify your benefits before your first appointment by calling the member services number on your insurance card. Key questions include whether podiatric visits require specialist referral, what your specialist copay or coinsurance rate is, whether prior authorization is needed for diagnostic imaging, and how many office visits per year are covered.

Balance Foot & Ankle accepts most major insurance plans including Blue Cross Blue Shield, Aetna, United Healthcare, Cigna, HAP, Priority Health, Medicare, and Michigan Medicaid. Our insurance verification team contacts your plan before your first visit to confirm coverage and estimate your out-of-pocket responsibility.

Use your flexible spending account (FSA) or health savings account (HSA) for podiatric expenses not fully covered by insurance. Custom orthotics, therapeutic shoes, copayments, and deductible amounts are all eligible FSA/HSA expenses. Planning these expenditures at the beginning of your benefit year maximizes the value of your tax-advantaged healthcare dollars.

Quick Reference: Michigan Insurance Coverage Chart

Insurer	Covers Podiatry?	Referral Needed?	Balance Foot In-Network?
Medicare Part B	Yes (medically necessary)	No	Yes
Medicare Advantage (various)	Yes	Check plan	Yes (most plans)
BCBS Michigan PPO	Yes	No	Yes
Blue Care Network HMO	Yes	Usually yes	Yes
Aetna	Yes	No (PPO) / Yes (HMO)	Yes
United Healthcare	Yes	Check plan	Yes
Cigna	Yes	Check plan	Yes
Humana	Yes	Check plan	Yes
HAP	Yes	Check plan	Yes
Yes	Check plan	Yes
Meridian	Yes	Check plan	Yes
Priority Health	Yes	Check plan	Check with office
Oscar Health	Yes	No	Yes
Workers’ Comp	Yes	Employer auth required	Yes
Medicaid / Healthy Michigan	Yes	May need referral	Yes

How We Verify Your Insurance

When you schedule your first appointment at Balance Foot & Ankle, our front office team will collect your insurance information and verify your benefits before your visit. This process confirms that your plan is active, identifies your copay, deductible, and coinsurance amounts, checks whether a referral is required from your primary care physician, and determines if any pre-authorization is needed for your anticipated services.

We do this verification work so you can focus on your health, not paperwork. If there are any issues with your coverage or if your out-of-pocket costs will be higher than expected, we’ll contact you before your appointment to discuss your options. There are no surprise bills at Balance Foot & Ankle.

What to Bring to Your First Visit

• Insurance card (front and back)
• Photo ID (driver’s license or state ID)
• Referral from your primary care physician (if your plan requires one)
• List of current medications
• Any previous imaging (X-rays, MRIs) related to your foot or ankle condition
• Completed new patient forms (available on our New Patient page or can be completed in-office)