Medical agreement physiotherapy
A lot of physiotherapy treatments are reimbursed by the statutory health insurance. In some cases, you will need explicit approval for this, in the form of a medical agreement. We've set it all out for you below.
Conditions with a medical agreement
F-pathologie
Bij een acute of chronische F-pathologie heb je een medisch akkoord nodig. Dan worden tot 60 kinesessies terugbetaald voor je behandeling.
E-pathologie of zware pathologie
In geval van een zware pathologie, of E-pathologie, heb je een medisch akkoord nodig. Je arts-specialist en kinesist dienen hiervoor een uitgebreid medisch dossier in.
Rug- of nekschool
In sommige gevallen heb je geen medisch akkoord nodig voor sessies in de rug- of nekschool, in andere gevallen wel. Ontdek hoe het voor jouw aandoening zit.
What is the application process?
Give the prescription from your treating physician for physiotherapy sessions to your physiotherapist.
- The request from the medical specialist, or a specialist report with diagnosis from the general practitioner
- The functional assessment
- The physiotherapy treatment plan
Submit all documents to the medical advisor of the health insurance fund:
- Via the Helan office in your area.
- Or drop them in a Helan mailbox near you.
- Or send them by post: Helan health insurance fund, Medical service - Boomsesteenweg 5, 2610 Wilrijk.
The medical advisor of the health insurance fund checks whether you meet the conditions to receive medical approval. Via My Helan you can always view the current status of your application.
Your physiotherapist and you will both receive a response from the medical advisor. There are 3 possible outcomes:
- Medical approval
You receive a letter with an ‘approval for reimbursement’. With this approval and the prescription, you can request reimbursement for your physiotherapy sessions.
- Request for additional information
Sometimes the medical advisor needs more information to make a decision. In that case, you will receive a letter requesting additional information. The health insurance fund will then wait for a response from your prescribing doctor/physiotherapist before making a final decision.
- Rejection
If you do not meet the INAMI/RIZIV regulations for reimbursement, your physiotherapist will be informed immediately. You will receive a ‘rejection for reimbursement’ by post.
Conditions without a medical agreement
Courante aandoeningen
Je hebt geen medisch akkoord nodig voor de eerste 18 sessies van het kalenderjaar. Voor de terugbetaling van bijkomende sessies moet je wel een aanvraag indienen.
Perinatale kinesitherapie
Je hebt geen medisch akkoord nodig voor sessies bij de kinesist voor of na je bevalling.
Reimbursement
Your physiotherapist will give you a certificate of provided care. Send us this document, together with the ‘authorisation’ from your health insurance fund and the prescription from your doctor. This allows us to process your reimbursement smoothly.
Practical questions and answers
As soon as the consulting doctor gives their approval, all previously rejected claims will be automatically reimbursed within five working days.
No. Approval for an E-pathology takes priority over all other forms of physiotherapy. If you already have such an active agreement, you cannot combine it with a medical agreement for physiotherapy, for example after knee surgery.
This does not mean that these sessions will not be reimbursed. Your physiotherapist can certify these treatments under the codes for severe pathology. This allows you to be reimbursed for up to 1 session per day.
If your physiotherapy sessions are not reimbursed, this is often because the maximum number of treatments has been exceeded. This can have different causes.
- You were treated by multiple physiotherapists and together they exceeded the maximum number of physiotherapy sessions.
- Your physiotherapist used the wrong code on the certificate.
- You have multiple conditions and therefore received several treatment pathways.
Even if you have used up the number of sessions, reimbursement is often still possible. Discuss this with your physiotherapist. They can submit a reimbursement request to the medical advisor of the health insurance fund. If nomenclature codes are rejected, they can correct them via a correction document from the health insurance fund. You can easily submit the completed correction document to Helan digitally.
