Provincial Government Funding
A. Prosthetics = PharmaCare
PharmaCare’s Prosthetic Program provides funding to help supply all current residents of BC with prosthetic treatment which allows them to maintain basic mobility. In order to be covered under this program, individuals must first register with PharmaCare. Once registered, each individual will be assigned a deductible and a family maximum based on their household income 2 years ago. Until the deductible is reached, the individual is responsible for paying 100% of the eligible costs**. Once the deductible is reached, PharmaCare pays 70% until the individual has paid the maximum, at which point PharmaCare pays 100% of eligible costs. Pentland’s will bill PharmaCare directly for their portion of the payment.
**It is very important to note that not all prosthetic costs are considered to be eligible by PharmaCare and individuals will need to pay for these ineligible costs themselves. For more information on what is covered, please talk to your Prosthetist.
B. Orthotics for Adults = Ministry of Housing and Social Development
The Ministry of Housing and Social Development provides funding of orthoses for eligible clients (over the age of 19) to meet a medically essential need. There must be no other resources available to the client to provide the item requested. To find out if you are eligible to receive funding from The Ministry, you may need to contact your local ministry representative.
As of April 1, 2011, the procedure to obtain funding from the Ministry for orthotics is as follows:
- Go to a local ministry representative (the nearest location can be found at the link below)
Ask them for form 2894 (Orthosis Request and Justification)
- Make sure the social worker signs the form where it says “Signature of Worker”.
- Please sign where it says “Client Signature”
- Call your doctor to make an appointment to get a referral
- Have the doctor fill out his/her position of the form (Section 2, page 1)
- Have the doctor’s office fax the form to our clinic or drop it off at our office. Our Orthotist will then fill in his section (Section 3, page 2). We will precede with the application once all the paperwork is filled out completely and correctly.
Once Approval is received, we will set up an appointment for you to come in to our office for a casting, fitting and follow-up.
Please know that approval from the Ministry can take anywhere from 30-90 days.
To find the office closest to you, please visit the Ministry website.
C. Orthoses for Children = PharmaCare At Home Program
PharmaCare’s Orthotic Program provides funding for orthoses for children under the age of 18 who are residents of BC. They cover 100% of orthotic treatments and any necessary adjustments and repairs, as long as the appropriate forms have been completed. Prior approval is required before starting a treatment, and after the final device is dispensed, Pentland’s will bill PharmaCare directly.
WorkSafe BC provides 100% coverage for people needing prosthetic and orthotic treatments due to workplace injuries. In order to ensure funding for prostheses and orthoses for all levels, it is necessary that injured workers see a Certified Prosthetist or Orthotist. After doing an initial assessment, the Prosthetist or Orthotist will submit a claim to WorkSafe BC which must be authorized before a treatment can be started. Upon completion of the treatment, clinics will bill WorkSafe directly.
ICBC provides funding for prosthetic and orthotic treatments required for injuries resulting from a motor vehicle accident. $150,000 is available for medical and rehabilitation expenses prior to a settlement. In order to access this funding the injured individual needs to have a valid ICBC claim number, as well as the name and contact number of their adjuster. Prior approval is required before treatment can begin, and Pentland’s will bill ICBC directly upon completion of the treatment.
Non-Insured Health Benefits – NHB
NIHB provides funding for prostheses and orthoses for First Nations and Inuit individuals. In order to apply for funding for all treatment, services or supplies, prescriptions from a doctor are first required. A request for prior approval will be sent to NIHB before treatment begins and Pentland’s will bill NIHB directly after the treatment is completed.
Department of Veteran Affairs – DVA
DVA provides funding for prostheses and orthoses for veterans who are eligible for benefits from service. A prescription from a doctor is required for all treatments and services provided. A request for prior approval will be sent to DVA before treatment begins and Pentland’s will bill DVA directly upon completion of the treatment.
Extended Health Plans, such as those offered by Pacific Blue Cross, Great West Life and others, can either be provided by employers or purchased privately. These plans are all unique and the funding they provide is based on the specific natures of each plan. To determine what is eligible for coverage under a specific plan, the plan provider must be contacted and asked what is covered and what paperwork is required. In all cases, the individual must pay Pentland’s directly and submit the receipt to the Insurance Company for reimbursement.
The War Amps CHAMPS program aims to encourage amputees 18 years old or younger to develop a positive approach to challenges. It does this in a variety of ways, including offering financial assistance, mentoring, seminars and other programs. To receive financial assistance, all other paying agencies must first be contacted and prior authorization must be attained. After the treatment is provided, Pentland’s will bill CHAMPS directly.
Other Funding Options
There are several other funding sources available to help cover the costs of some prosthetic and orthotic treatments. These include the Challenged Athletes Foundation, Variety Children’s Charity, President’s Choice Children’s Charity and the PLAY Foundation. For more information on whether these organizations may be able to help you, please contact our office or your Prosthetist.