Funding Info
The cost of a prosthesis or orthosis can seem daunting. There are several avenues of funding available that we are happy to walk you through and answer any questions. Below are a few details to see if you have coverage. If you don’t seem to meet the eligibility, give us a call and we can guide you through what next steps are available to you.
Health Services and Social Development
- If you have a Health Services Card showing “Supplementary” in the BASIC HEALTH ELIGIBILITY section, or “OR” (Orthotics)/“PR”(Prosthetics) in the ADDITIONAL HEALTH ELIGIBILITY section…
- Or if you have a valid Yellow Health Services card with a “Y” under the OTH in the VALID ONLY FOR box, or an “X” under SUPP in the VALID ONLY FOR box.
- For Orthotics, Health Services will not cover devices if the patient holds any other coverage (insurance) for the same service.
- For Prosthetics, if a patient with other coverage (insurance) is unable to pay the co-pay, Social Development may assist with the difference they owe as long as the device does not cost more than the maximum amount allowed by the department. This varies depending on the level of prosthesis that is needed (Below knee, Above knee, etc.) as their maximum allowable is different for each level.
- Documents are needed by Health Services including a completed Health Services Limb Prosthesis Application Form, an original prescription, and quote and itemized list for the prosthesis that we will provide. Also, when cost sharing with a private insurance, a statement of benefits and predetermination from them is needed.
Private Insurance
- Private Insurance has wide variability on what is covered. We accept all insurances.
- We will submit a predetermination on your behalf. You can call and ask your insurance company for a verbal confirmation of what coverage you have for the device or supplies that are needed. However, the predetermination will let us know the exact amount that will be covered at the time of service. We will need that in order to bill the insurance company. The insurance approval of the predetermination will be good for 1 year.
The War Amps
- Adults – The War Amps can help with funding for a prosthesis, however the amount they can assist varies yearly. You’ll need to register with their Adult Amputee Program and you can do that here: https://waramps.ca/ways-we-help/adult-amputees/
- Children – The CHAMPs program provides comprehensive coverage for children with amputation until age 18. Parents can enroll for that here: https://waramps.ca/ways-we-help/child-amputee
Blue Cross Senior Health Plan
- For New Brunswick residents over 65 we encourage you to apply for their Seniors Health Program. They can provide up to 80% coverage.
- You will need to apply within 60 days of your 65th birthday, otherwise you’ll still be able to apply but there will be a one year delay in the onset of coverage.
Work Safe
- If you’ve had an injury as a result of your work, Work Safe NB will cover a device for you. https://www.worksafenb.ca/policy-and-legal/policy/view-our-policies/prostheses-orthoses-and-assistive-devices
If you didn’t find the answer to your question here, please give our office a call. 506-635-4600 .