Does health insurance pay for lymphatic drainage?

What basic health insurance pays

In basic health insurance, manual lymphatic drainage is not a separate benefit but part of physiotherapy. Art. 5 KLV explicitly lists “lymphological physiotherapy” among the measures the insurer pays for (para. 1 let. b no. 6). It must be ordered by a physician and provided by a licensed physiotherapist or physiotherapy organisation (Art. 25 para. 2 let. a no. 3 KVG, Art. 47 and 52 KVV).

Quantities: The insurer pays for at most nine sessions per physician’s order. The first must take place within five weeks of the order (Art. 5 para. 2 KLV). Further sessions require a new order (para. 3). If therapy is to continue after 36 sessions, the physician sends the medical adviser a report with a reasoned proposal; the medical adviser proposes whether, to what extent and for how long the insurer continues to pay (para. 4). For longer-term lymphatic drainage, this report is therefore a fixed step.

Individual therapy: The ordinance allows certain forms of physiotherapy to be provided in groups as well. Lymphological physiotherapy is not one of them; it takes place as individual therapy (Art. 5 para. 1bis KLV).

Compression items: The FOPH’s Aids and Appliances List (MiGeL) contains a separate group of compression therapy items for venous and lymphatic drainage disorders. Basic health insurance reimburses these products if a physician orders them and a licensed dispensing point supplies them (Art. 20 para. 1 KLV). It pays at most the maximum reimbursement amount in the list; if the product is more expensive, you pay the difference (Art. 24 para. 3 KLV). Some items have limitations, for example regarding the dispensing point.

Accident: If an accident is the cause, accident insurance pays for treatment by a medical auxiliary ordered by a physician and for the aids and appliances that serve recovery (Art. 10 para. 1 let. a and e UVG), without the health insurer’s deductible or retention fee.

Children with congenital disorders: For recognised congenital disorders, invalidity insurance pays for prescribed physiotherapy until the age of 20 is reached (Art. 13 and 14 IVG). If physiotherapy continues after that, the rule after 36 sessions applies to the continuation (Art. 5 para. 5 KLV).

What supplementary insurance pays

Lymphatic drainage is also offered by therapists who may not bill basic health insurance, such as medical masseurs or naturopaths. Their treatments are only paid for, at most, by supplementary insurance. This is governed by the ICA (Art. 2 para. 2 KVAG), and each insurer sets out in its general insurance conditions what it pays. Typical rules in supplementary outpatient insurance:

• Recognition: The insurer only pays for recognised therapists. Some insurers rely on a register such as the EMR; your own insurer’s list is decisive.
• Amount: a percentage of the bill, or a maximum amount per session or per calendar year.
• Prescription: Some contracts pay without a physician’s order, others require a physician’s recommendation.
• Abroad: Basic health insurance only pays for treatment abroad in an emergency or if the service cannot be provided in Switzerland (Art. 36 para. 1 and 2 KVV); whether supplementary insurance steps in is set out in its general insurance conditions.

Supplementary insurance may not cover the deductible and retention fee of basic health insurance (Art. 64 para. 8 KVG). We are building a comparison of the benefits of supplementary products under Supplementary insurance. The general insurance conditions and the information from your insurer are decisive.

Conditions

• Physician’s order: Without a prescription, basic health insurance does not pay for lymphatic drainage (Art. 5 para. 1 KLV).
• Five-week deadline: The first session must take place within five weeks of the order; otherwise you need a new prescription.
• Licensed physiotherapist: Physiotherapists with a cantonal licence, two years of practical experience and who meet the quality requirements may bill (Art. 47 KVV), as may licensed organisations (Art. 52 KVV). Further training in lymphatic drainage alone does not make a massage practice a service provider for basic health insurance.
• Report after 36 sessions: Without a proposal from the medical adviser, the insurer does not pay for further sessions.
• Compression items separately: They require their own physician’s order and a dispensing point; the insurer pays at most the amount in the MiGeL.
• Deductible and retention fee: The sessions count towards the deductible; after that, you pay a 10 % retention fee up to CHF 700 a year, children with no deductible up to CHF 350 (Art. 64 para. 2 and 4 KVG, Art. 103 KVV).

Sample calculation

Example with fictitious people and an assumed price per session. Heidi is 59 and has the standard deductible of CHF 300. Her physician prescribes lymphological physiotherapy, first nine sessions, then another nine with a second order. A session costs an assumed CHF 70.00; the actual amount depends on the tariff and the duration. Heidi has no other medical bills this year. Deductible and retention fee are the statutory values from Art. 64 KVG and Art. 103 KVV.

Whether a low or a high deductible is cheaper depends on your expected costs. You can work out the break-even point in the deductible calculator and compare premiums in the premium calculator. A lower deductible for the next year must reach your insurer by 30 November; the dates are listed under Deadlines.

How to proceed

1. Get a prescription: Have lymphatic drainage prescribed as physiotherapy before you book the first appointment.
2. Check the licence: Ask the practice whether it bills basic health insurance as physiotherapy. If not, check with your insurer beforehand whether your supplementary insurance recognises the therapist.
3. Start within five weeks and keep count of the sessions: a new order after nine, the report to the medical adviser after 36.
4. Compression items: Have them prescribed separately and ask the dispensing point whether the price is above the MiGeL amount.
5. Check the bill: The health insurer profiles show how insurers organise contact and reimbursement.

Common mistakes

• Starting without a prescription. Basic health insurance does not pay for sessions before the physician’s order.
• Confusing a massage practice with physiotherapy. Only licensed physiotherapists bill basic health insurance.
• Letting the five weeks pass. If therapy starts later, the prescription is no longer valid.
• Not checking the price of compression stockings. You pay the difference above the maximum reimbursement amount yourself.

The general rules are on the page Physiotherapy, and who is recognised as a therapist is explained in Recognised therapists. When your insurer pays for a second medical opinion is set out on the page Second opinion, and what applies to treatment across the border under Treatment abroad. You can find all benefits in the overview What does health insurance cover?.