Physiotherapy

What is physiotherapy?

Physiotherapy treats restrictions of movement and bodily functions. In basic health insurance it is precisely defined: it is used to treat diseases of the musculoskeletal or neurological system or of the internal organs and vessels, insofar as these can be treated with physiotherapy. Typical cases are treatment after operations, for back and joint complaints, for diseases of the nervous system or for breathing problems.

The KLV lists exhaustively which measures basic health insurance covers:

• Examination and assessment by the physiotherapist.
• Treatment, advice and instruction: active and passive movement therapy, manual therapy, respiratory physiotherapy, medical training therapy, lymphological physiotherapy, movement therapy in water, cardiovascular and pelvic floor physiotherapy and other listed methods.
• Physical measures: heat and cold therapy, electrotherapy, light therapy, ultrasound, hydrotherapy, muscle and connective tissue massage.
• Fall prevention for people aged 65 and over with a moderate or high risk of falling, under set programmes.

Physiotherapy should be distinguished from occupational therapy, which trains everyday skills, and from osteopathy, which is not one of the benefits listed in Art. 5 KLV. A massage outside prescribed physiotherapy is not a compulsory benefit either.

How it works

Doctor’s prescription. The doctor issues a prescription. It is valid for at most nine sessions. The first treatment must take place within five weeks of the prescription. If it starts later, ask for a new prescription.

Further series. Additional sessions require a new prescription. For example, four series of nine sessions each are possible.

After 36 sessions. If the therapy is to continue, the treating doctor reports to the insurer’s medical adviser and proposes continuation. The medical adviser recommends whether, to what extent and for how long the insurer continues to pay.

Medical training therapy. It starts with an introduction to the equipment after an individual treatment and must be completed at most three months after the introduction.

Licensing. Physiotherapists and organisations licensed under the KVV may bill basic health insurance.

Costs for you. You pay the deductible and the 10% retention fee, up to CHF 700 a year for adults. Physiotherapy has no separate co-payment of its own.

Legal basis

Art. 25 para. 2 let. a KVG includes among the compulsory benefits treatment by persons who provide services on the prescription or on behalf of a doctor. Art. 5 KLV specifies this for physiotherapy: para. 1 lists the measures and requires a doctor’s prescription and a licence under Art. 47 or 52 KVV. Para. 1ter limits medical training therapy to three months after the introduction. Para. 2 limits a prescription to nine sessions, starting within five weeks, para. 3 requires a new prescription for further sessions, and para. 4 governs the procedure with the medical adviser after 36 sessions. The co-payment follows from Art. 64 KVG and Art. 103 KVV.

Example: physiotherapy after an operation

Marta, 52, needs regular physiotherapy after an operation. Her doctor issues three prescriptions of nine sessions each, one after the other. Marta has a CHF 300 deductible, which she has not yet used up this year. The cost per session depends on the tariff; a total of CHF 2,700 for 27 sessions is assumed here.

Prescription	Sessions	Requirement
1	1 to 9	Start within five weeks of the prescription
2	10 to 18	New doctor’s prescription
3	19 to 27	New doctor’s prescription
from session 37	–	Report to the medical adviser and approval by the insurer

You can see which deductible suits regular therapy in the premium calculator, which shows the premiums for all deductible levels.

What this means for you

1. Get a prescription before the first appointment. Without a doctor’s prescription, basic health insurance does not pay. Keep the five weeks until the first session in mind.
2. Count your sessions. After nine sessions you need a new prescription. Book the doctor’s appointment in good time.
3. Check the licence. Ask the practice whether it bills basic health insurance.
4. Adjust your deductible. If a longer course of therapy is foreseeable, a lower deductible may be cheaper. The notice deadlines are listed under deadlines.
5. Check additional benefits. Services without a prescription or outside the KLV may be covered by supplementary insurance. The profiles under health insurers show what the insurers offer.

After a hospital stay, rehabilitation may be an option instead of outpatient physiotherapy.

Common mistakes

• Going to physiotherapy without a prescription. Basic health insurance will not pay in that case.
• Forgetting the new prescription. Sessions beyond the ninth are not covered without a new prescription.
• Confusing a wellness massage with physiotherapy. Only measures from the KLV prescribed by a doctor are compulsory benefits.
• Underestimating the deductible. With a high deductible you often pay for an entire series of therapy yourself.