Footcare with diabetes from 2015
Starting from 2015 there have been a few changes in the way foot care for people with diabetes mellitus is organised. Below you can read about the changes that have been made.
Foot care has been divided into care profiles since the first of January 2015. Previously the so-called Simms classification was a leading factor for getting a reimbursement from the basic health insurance package. Since the first of January 2015, care profiles are the leading factor for getting a reimbursement. There are 4 care profiles (1 till 4), each profile means that the higher the number, the more foot care is necessary. If your number is high this means the risk of getting a wound is higher. A podiatrist can determine your care profile, however, your general practitioner has the final say and is the one responsible for your care profile. The height of your care profile (1 – 4) determines how many sessions you need and if the treatment can be reimbursed via your health insurance company.
Your personal care profile is a requirement to be eligible for a reimbursement out of the basic health insurance package for foot care. The height of this profile determines if you get a reimbursement and if so, if this is out of the basic health insurance package or the additional health insurance package. Patients who used to have a Simms classification 1 now fall under care profile 1 or care profile 2. The choice between the two has to do with a higher risk of skin problems (for example). Patients who used to have a Simms classification 2 or 3 also fall under a care profile since 2015. In their case this could be care profile 2,3 or 4.
Reimbursement basic health insurance package
When you fall under care profile 2,3 or 4 you are eligible for a reimbursement out of the basic health insurance package for preventive foot care. You will then get a referral to go to a podiatrist. The podiatrist will exam your feet and write a personal treatment plan. In this plan is mentioned how much foot care you need from a podiatrist and/or pedicure, for example. You can discuss who your pedicure is with your podiatrist.
Reimbursement additional health insurance package
For care profile 1 it might be possible to get a reimbursement out of the additional health insurance package. This depends on your health insurance company and your policy conditions. We advise you to check your policy carefully. If you are not capable to take care of your feet sufficiently, it is important to visit a pedicure (who has experience with diabetes patients), even if the treatment is not reimbursed since 2015.
The necessary medical care is directly declared by the podiatrist at your health insurance company. Your podiatrist receives a standard payment, depending on your care profile. The amount that your podiatrist receives from the basic health insurance package is used to pay the pedicure for the necessary medical care. You will not receive an invoice for this. For possible additional actions by the pedicure you could be charged directly.
Coordinating role for the podiatrist
Since the first of January 2015 a podiatrist will fulfil a coordinating role in foot health care. When a care profile is determined, your podiatrist will draw up a personal treatment plan for the entire year (together with you). Your podiatrist will discuss this with your general practitioner and, if necessary, the pedicure as well, and keep the medical file up to date concerning diabetic foot care.
What do these changes mean for you?
Do you have diabetes mellitus and has a general practitioner, nurse of podiatrist ever diagnosed you with a low, medium or high risk of getting a wound (the so-called Simms classification)? Then it is important to get a care profile under the supervision of your general practitioner. Besides this, your podiatrist will draw up a personal treatment plan. Your podiatrist will discuss this with your general practitioner and, if necessary, the pedicure as well, and keep the medical file up to date concerning diabetic foot care. Take note that your pedicure has a contract with us. Only then will you be eligible for a reimbursement.
Check here to see which pedicures work together with our practice. These pedicures can look after your foot care (which is reimbursed by your insurance, depending on your care profile).