Get Your Night Splint Covered
Choose how you'd like to pay below. We'll walk you through each option step by step.
Option A: Pay with HSA or FSA card
Fastest — save 20–40% with pre-tax dollars
Option A: Pay with HSA or FSA card
Fastest — save 20–40% with pre-tax dollars
- 1
Check your card
Look for an HSA or FSA debit card from your benefits provider (e.g. Optum, HealthEquity, WageWorks). It works like a normal Visa or Mastercard.
- 2
Order the splint
Use your HSA/FSA card at checkout. The charge is deducted from your pre-tax balance.
- 3
Keep your receipt
We email you an itemized receipt. Save it in case your plan administrator asks for proof of eligibility.
Option B: Reimburse yourself from HSA/FSA
Pay now, get money back from your pre-tax
account
Option B: Reimburse yourself from HSA/FSA
Pay now, get money back from your pre-tax account
- 1
Order with any card
Use a personal credit or debit card at checkout.
- 2
Get your itemized receipt
We email an itemized receipt with the product name, date, and amount.
- 3
Submit a claim
Log in to your HSA/FSA portal or app and file a reimbursement claim. Upload the receipt. If they ask for a Letter of Medical Necessity, use the note from your surgeon (see below).
- 4
Get paid back
Your provider reviews the claim and issues a direct deposit or check, typically within a few business days.
Option C: File an out-of-network insurance claim
Submit billing codes to your health insurer for
reimbursement
Option C: File an out-of-network insurance claim
Submit billing codes to your health insurer for reimbursement
- 1
Order with any card
Pay at checkout. We are not an in-network provider, so you pay upfront.
- 2
Get your itemized receipt
We send you an itemized receipt that works as a "superbill" with:
HCPCS code: L4397 — Off-the-shelf ankle-foot orthosisAdd -RT (right) or -LT (left) if your insurer asks for a laterality modifier.
ICD-10 diagnosis:Spontaneous rupture: M66.361 (right) / M66.362 (left)
Traumatic rupture: S86.011A (right) / S86.012A (left)
Use whichever matches your doctor's documentation. If unsure, ask your doctor.
- 3
Get a Letter of Medical Necessity
Ask your surgeon or doctor for a note (or use your existing referral) stating the night splint is prescribed for your Achilles rupture recovery. Insurers often require this.
- 4
Submit to your insurer
File an out-of-network claim with your health insurance. Attach the receipt, billing codes, and Letter of Medical Necessity. Most plans let you file online or via their app.
- 5
Get reimbursed
Your insurer reviews and reimburses you (amount depends on your plan's out-of-network benefits and deductible).
Common questions
What is a Letter of Medical Necessity?
A short note from your doctor stating the night splint is medically necessary for your Achilles rupture recovery. Your surgeon's prescription or referral letter usually counts. Submit it with your claim if your insurer or HSA/FSA plan asks for one.
What if my HSA/FSA card is declined at checkout?
Some plans restrict which merchants can charge HSA/FSA cards. Just pay with a regular card and follow Option B to reimburse yourself from your HSA/FSA after purchase.
Will my insurance definitely cover it?
We can't guarantee approval—it depends on your plan. But orthopedic splints for a diagnosed condition are commonly covered, especially with proper documentation. Contact your insurer to check your out-of-network benefits before ordering if you want to be sure.
I have a "Limited Purpose" FSA (LPFSA). Am I covered?
Limited Purpose FSAs typically only cover dental and vision expenses. A standard Health FSA or HSA is what covers orthopedic devices like this splint. Check with your plan administrator.
Reimbursement and eligibility depend on your individual plan. Thetis Medical does not guarantee insurance approval. Always verify coverage with your insurer or HSA/FSA administrator before purchasing.