Who may prescribe occupational therapy in Switzerland?
It always needs a medical order. Any doctor may prescribe it, whether a family practice, hand surgery, neurology or rheumatology. Referring yourself is not enough. Chiropractors may order physiotherapy but not occupational therapy, because the federal ordinance ties it to the medical order alone.
The federal ordinance on benefits in compulsory health insurance ties occupational therapy to two conditions. First, it has to be ordered by a doctor. Second, the therapist has to be admitted to bill the insurer, either as an individual or through an admitted organisation. The health insurer checks both before it pays.
Federal law does not prescribe a particular medical speciality. In practice the prescriptions come mostly from family medicine or from the specialist who treated an operation or a stroke. Which speciality prescribes changes nothing about your entitlement. Those who prescribe find the documents under information for referrers.
- The prescription carries your personal details, the diagnosis and the task given to the therapy.
- If treatment at home is meant, that has to be stated on it expressly.
- After an accident the accident report belongs with it, not the health insurance card alone.
Which of the three fields fits your prescription, hand therapy and orthopaedics, neurology or care of older people, we settle at the first contact. An overview is given under our specialities.
How many sessions does one prescription cover?
The insurer covers at most nine sessions per prescription; long-term prescriptions are the exception. The nine treatments do not have to be used up. If they are not enough, your doctor writes a new prescription. How many you need in the end depends on the course.
The number nine stands in the federal ordinance and applies throughout Switzerland. It is an upper limit and not a credit that has to be spent. Even after five appointments, say, an end of treatment can be agreed together.
How often you come is not laid down in law. After hand surgery two appointments a week often make sense at the start and one later, because the practising happens between the appointments. In neurological courses the intervals are often more even and the period longer.
A prescription for nine sessions therefore means neither nine weeks nor nine months, but an upper limit for billing that says nothing about the timing.
How long is a prescription for occupational therapy valid?
The first treatment has to take place within eight weeks of the date of the medical order. That is the only time limit federal law lays down here. Anyone starting later needs a new prescription. A general expiry date for the remaining sessions does not exist in the federal ordinance.
This eight-week limit is the reason why it pays to telephone straight after the appointment with the doctor. It counts from the date on the form, not from the day you take it out of the post. In physiotherapy it is five weeks, which regularly causes confusion.
There is no public Swiss statistic on waiting times for a place in therapy, and any figure would be guesswork. What you can steer is when you call. Say on the telephone what date the prescription carries, and the first appointment can be arranged around it.
For the sessions after the first treatment, federal law names no expiry date. If many months lie between two appointments, ask your health insurer beforehand whether it still recognises the old prescription.
Who pays for occupational therapy and how is it billed?
In case of illness compulsory health insurance pays, that is the basic insurance. You carry your share of it: first the deductible, then ten per cent of the remaining cost as a retention fee, until the yearly maximum is reached. Both run over the calendar year and over all treatments together.
Occupational therapy is a compulsory benefit of basic health insurance when it is ordered by a doctor and when it improves independence in daily life or belongs to a psychiatric treatment. You do not need supplementary insurance for it.
Deductible and retention fee
The deductible (Franchise) is the fixed yearly amount you carry yourself before the insurer pays anything at all. What goes beyond it you share with the insurer: ten per cent stays with you as the retention fee (Selbstbehalt), until the yearly maximum is reached. For children there is no deductible and a lower maximum for the retention fee.
How high the two are in your case depends on your model and is stated on your policy. For amounts ask your health insurer; it is the only body that can tell you bindingly. If you have already paid a great deal in the current year, your share of the occupational therapy may be small or fall away entirely.
- The bill normally goes straight to the insurer that is responsible.
- If it comes to you by way of exception, you submit it to the insurer and get back the part that goes beyond deductible and retention fee.
- Missed appointments that are not cancelled in time are not a benefit of the insurer.
What applies after an accident and what under invalidity insurance?
If an accident was the cause, as a rule the accident insurer pays. For accidents that run through the employer’s compulsory accident insurance, deductible and retention fee do not apply. If the accident is covered through the health insurer, they apply as in illness. Invalidity insurance covers birth defects and measures up to the age of twenty.
Anyone who is employed and works at least eight hours a week is insured through the employer under the Accident Insurance Act, and so are people who are unemployed. After a fall on the hand or a bicycle accident, treatment then runs through that accident insurer, and your share of the treatment cost is nil. The condition is that the accident has been reported and a case opened.
Anyone not insured under that Act, that is pensioners, children, students and people not in employment, is insured against accidents through the health insurer. The health insurer then covers the occupational therapy as accident insurer, and deductible and retention fee arise exactly as in illness.
- Report the accident to your employer or, if you are not employed, to your health insurer as accident insurer.
- Note the claim number as soon as you receive it.
- Give the claim number and the insurer to the therapy practice before the first bill arises.
- If responsibility stays disputed, treatment runs through the health insurer for the time being and is rebooked later.
Invalidity insurance has rules of its own. It pays medical measures for birth defects and measures of integration up to the completed twentieth year of age. After that an occupational therapy already under way passes as a rule to the health insurer, and the rules of basic insurance apply again for its continuation.
Anyone covered by military insurance likewise carries no share of the cost. Which insurer is responsible is best settled before the first appointment, not after the first bill. If anything is unclear, a short call helps: get in touch.
How does an extension of the prescription work?
If the nine sessions are used up and treatment is not finished, a new medical order is needed. The therapy records the course for that purpose. From a total of thirty-six sessions it becomes more formal: your doctor justifies the continuation to the insurer’s medical adviser.
The extension is the normal case, not the exception. Nine sessions are often enough after a small operation, and rarely after a stroke or with a complex hand injury. The procedure is designed for exactly that: short stretches, and each time afterwards the question whether the therapy is still achieving something.
- Towards the end of the current prescription we talk with you about where things stand and whether continuing makes sense.
- The therapy sends the course of treatment to the prescribing practice.
- Your doctor decides and, if needed, writes a new prescription.
- From a total of thirty-six sessions a reasoned proposal to the insurer’s medical adviser is added.
The medical adviser examines the proposal and recommends to the insurer in what scope and for what period the therapy continues. The decision is taken by the insurer. This intermediate check is not a refusal in advance, and it turns out the simpler the more concretely the goal is put.
What happens at the first appointment?
The first appointment is an assessment. You describe what no longer works in daily life, after which mobility and strength are examined as far as your complaints allow. Out of that comes a goal in your own words, such as doing up a shirt or carrying the shopping bag.
The assessment is not a lost session but the basis for everything that follows. Without a goal you have put into words yourself, the therapy stays a collection of exercises, and the application for an extension has no measure.
- the medical prescription, the original
- your insurance card, and after an accident the claim number as well
- medical reports, X-ray findings or operation reports, which carry very useful information for the therapy
- splints, bandages or assistive devices you already use
If the way to the practice is not possible, treatment at home can be arranged, provided the doctor notes it on the prescription. We drive out to the communes around Thalwil for that.