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Old 22.02.2012, 18:20
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not reimbursed for insoles by health insurance

My health insurance company (swisscare) is refusing to pay for insoles prescribed by a doctor. I was diagnosed with a degenerated tendon and one part of the therapy was wearing custom-designed insoles. I had to pay for them up front (they are not cheap at all), as for everything else, but when I asked for reimbursement, they refused under the pretext that insoles are not covered by the basic health insurance. The doctor told me they should be covered, and that I should instruct the company to call him if there are any problems. However, again the company said that insoles are not covered under some law (Art. 23 Migel: „Schuheinlagen sind grundsätzlich keine Pflichtleistung der obligatorischen Krankenpflegeversicherung.“).

What should I do? Is this something that I should be reimbursed for or not?!
Any help would be appreciated!
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Old 22.02.2012, 18:34
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Re: not reimbursed for insoles by health insurance

Hi Lily, the insoles should be reimbursed by your health insurance company if you have a doctor's prescription. I would ask the insurance company for a copy of your contract with them, asking them to point-out the Statute which states they have no obligation to reimburse you.
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Old 22.02.2012, 18:38
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Re: not reimbursed for insoles by health insurance

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However, again the company said that insoles are not covered under some law (Art. 23 Migel: „Schuheinlagen sind grundsätzlich keine Pflichtleistung der obligatorischen Krankenpflegeversicherung.“).
That, unfortunately, is correct.
Quote:
Schuheinlagen werden grundsätzlich von der obligatorischen Krankenversicherung nicht vergütet. Eine Vergütung erfolgt nur subsidiär zur IV, in den Fällen, wo die medizinischen Voraussetzungen der IV-Bestimmungen erfüllt wären, die antragstellende Person aber die versicherungsmässigen
Voraussetzungen für den Bezug von Leistungen der IV nicht erfüllt. Die Vergütung erfolgt gemäss Bestimmungen der IV.
i.e. basic health insurance will only pay for insoles if you could have them paid, from a medical point of view, by invalidity insurance (IV), but don't meet the eligibility requirements of the IV in the first place.
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Old 26.02.2012, 22:17
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Re: not reimbursed for insoles by health insurance

But the complimentary insurance, assuming you have one, would pay for them. There is a yearly limit.
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Old 26.02.2012, 22:59
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Re: not reimbursed for insoles by health insurance

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But the complimentary insurance, assuming you have one, would pay for them. There is a yearly limit.
Yes, this. Do you have complimentary insurance for "Medikamente und Hilfsmittel"? I think but am not 100% sure that that's the complimentary insurance which covers insoles prescribed by doctors (I don't know if the coverage differs depending on which company is covering the complimentary insurance, though).

Hope you get it sorted.
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Old 28.02.2012, 15:40
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Re: not reimbursed for insoles by health insurance

The basic insurance does not reimburse them (which is a pain as they're pretty expensive!) even if you have a prescription for them.

They may be reimbursed by your supplementary insurance if you have it but it depends who with etc.

I would contact your supplementary insurance provider and ask them.
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