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Preventive foot care

Reimbursement health insurance 2019

  1. What is preventive foot care?
  2. Overview profiles and reimbursement foot care
  3. Maximum rates non-contracted care providers
  4. No statutory personal contribution
  5. Excess
  6. Who can you go to?
  7. Referral for preventive foot care required

Note: the information on this page is a brief outline of the reimbursement. You can only derive rights from our insurance conditions (pdf).

1. What is preventive foot care?

You are entitled to preventive foot care provided by general practitioners and medical specialists if you have Diabetes Mellitus type I or II. Preventive foot care encompasses the full package of activities within care profiles 1 to 4, as described in the ‘2014 Prevention of Diabetic Foot Ulcers Care Module’. An individual treatment plan determines the actual amount of treatment you will receive.

 

Preventive foot care includes:

  • an annual foot check,
  • specific foot examinations and any treatment of skin and nail problems, deviations in the foot shape and position and the treatment of risk factors. To qualify, you must have a moderately increased (Simm's Classification 1) or increased risk (Simm's Classification 2 or 3) of inflammation, artery problems and loss of sensation in your feet;
  • information and encouragement to modify your lifestyle as part of the treatment;
  • advice on suitable footwear.


Diabetic foot care is subdivided into the care profiles according to the Simms's classification and several other factors. Your general practitioner determines your care profile.

 

Non-therapeutic actions, such as the removal of calluses for cosmetic or therapeutic reasons and the cutting of toenails, do not fall under preventive foot care.

 

Preventive foot care can be part of integrated care or medical specialist care. When this is the case, you will receive reimbursement on the grounds of the article on integrated care or (general) medical specialised care.

2. Overview of profiles and reimbursements for chiropody

Reason for pedicure/podology treatment     Reimbursement
Diabetes mellitus type I or II Care Profile 0

You do not qualify for a reimbursement under the public healthcare insurance.

Diabetes mellitus type I or II Care Profile 1 You qualify for one foot examination once a year under the public healthcare insurance.
Diabetes mellitus type I or II Care Profile 2 to 4 You qualify for a reimbursement under the public healthcare insurance.

Podiatry, podology;

You qualify for a reimbursement for pedicure treatment if you suffer from:

  • rheumatoid arthritis (a form of rheumatism) affecting the feet; or
  • an impaired sensation in your feet (peripheral neuropathy) not caused by diabetes.

You do not qualify for a reimbursement under the public

healthcare insurance. Right, if any, to a reimbursement

for chiropody under the Plus and Top supplementary

insurance contracts.

3. Maximum rates non-contracted care provider

We apply a maximum reimbursement for preventive foot care provided by a non-contracted podiatrist. In that case, the reimbursement is limited to the rates in accordance with the rates list for non-contracted care.  

 

When you go to a non-contracted care provider, then you should send a copy of the referral in the presentation of the first note. The note should make clear what care you received.

4. No statutory personal contribution

There is no statutory personal contribution for preventive foot care.

5. Excess

The costs of preventative foot care do not count towards compulsory and, if applicable, voluntary excess.

6. Who can you go to?

The following care providers are permitted to provide this type of care:

 

For care profile 1:

  • a general practitioner who is independently established or works in a general practitioner services structure (GP out-of-hours surgery) or a GP centre;
  • a podiatrist;
  • a pedicure provider.

For care profiles 2 to 4:

  • a general practitioner who is independently established or works in a general practitioner services structure (GP out-of-hours surgery) or a GP centre;
  • a podiatrist.

A chiropodist may independently perform the annual foot inspection for care profile 1. A chiropodist may  provide care for care profile 2 and higher if requested by the podiatrist. In that case, the podiatrist acts as the  medical specialist who is ultimately responsible and sends the invoice to the podiatrist.

 

Our Care Guide helps you find a care provider near you. For more information, please call our Care Advice Line on 0570 68 74 70. Our expert staff will be pleased to answer your questions.

7. Referral for preventive foot care required

You need a referral from a general practitioner or medical specialist in order to receive foot care from a chiropodist or a podiatrist. The referral must state the type of diabetes and the care profile.

 

If a non-contracted care provider provides the care, you must include a copy of the referral when you submit the first invoice. The invoice must show which type of care has been provided.



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