In order to be entitled to a reimbursement by the National Health Fund or the competent public sector fund, all acts and services provided by speech therapists must be prescribed by a doctor.
Conditions of coverage
Medical prescription: Content and duration of a session
The treatment must be prescribed on a medical prescription, which must indicate the medical diagnosis, the beginning of the ailment, the code or label of the nomenclature relating to the prescribed acts as well as the precise number of sessions.
Certain acts of the speech therapists’ table of acts and services indicate a maximum number of sessions that can be covered.
The minimum duration of an individual session is set at 30 minutes (preparation time not included). For speech therapy group sessions, the minimum duration is 60 minutes for two patients and 75 for three patient. The speech therapist invoices each insured person without any discount.
Foreign prescriptions must contain the same indications as prescriptions issued by doctors in Luxembourg. Furthermore, they must be issued in French, German or English. Prescriptions in other languages are returned, as they cannot be processed by the CNS.
Age of the beneficiary
Certain acts provide for an age limit or age range. In this case, the age limit or age range is clearly specified in the label of the act.
Validation of the prescription
The CNS must validate the prior medical prescription.
Usually, the insured person hands the medical prescription over to the speech therapist during their first session. The therapist then submits the prescription to the CNS for validation. If the administrative conditions are met, the CNS validates the prescription. The validation must be requested within 30 days of the medical prescription’s issue date.
Authorisation and prior authorisation by the Medical Board of the Social Security
In addition to the validation of the prescription by the CNS, certain acts and services by speech therapists can only be covered with an authorisation by the Medical Board of the Social Security. These acts are marked with the letters APCM (autorisation préalable du Contrôle médical requise = prior authorisation by the Medical Board required) or the letters ACM (autorisation du Contrôle médical requise = authorisation by the Medical Board required), depending on whether or not the authorisation must be given prior to the delivery of the act.
Certificate of coverage
The validation and, if necessary, the authorisation take the form of a certificate of coverage issued by the CNS.
The certificate of coverage provides information on the number of sessions covered as well as the coverage rate.
The treatment must be started at the latest within six months following the prescription’s issue date.
Travel costs incurred by the speech therapist, which include the travel allowance as well as travel expenses per kilometre, can be covered, provided that :
- the doctor specifies on the prescription that it is medically necessary for the speech therapist to provide the treatment at the insured person’s home.
- the journey takes place inside Luxembourg. Journeys beyond the border are not covered.
Travel expenses per kilometre can be invoiced only for journeys outside of the locality where the therapist has set up their practice and inside of the locality, if the journey exceeds one kilometre. However, travel expenses may not exceed the costs corresponding to the actual distance travelled.
If these conditions are fulfilled, travel costs are covered at the same rate as the speech therapy treatment provided at home.
Compensation for lost fees
If the insured person failed to keep an appointment or was away from home at the time they were supposed to receive the treatment, and if the insured person failed to notify the therapist at least during the day before the appointment, the therapist is entitled to a compensation for lost fees. This compensation, as well as potential travel costs incurred, are not covered by health insurance.
Coverage of costs
Method of payment
Usually, or upon request by the insured person, the portion covered by health insurance is directly covered by the CNS.
Third-party system also applies when:
- The insured person receives acts as part of the accident insurance association (Association d’assurance accident AAA),
- The insured person receives acts as part of an in-patient treatment in a hospital or
- Travel allowances as well as travel expenses per kilometre arise.
As part of the third-party system, the insured only pays the portion of the costs not covered by health insurance.
Upfront payment by the insured person
If the third-party system is not applied, the speech therapist issues an invoice, which must be paid upfront by the insured person. The invoice shows the total amount to be paid, in other words the portion of the costs covered by health insurance as well as, if applicable, the portion of the costs to be borne by the insured person. After settling the invoice, the insured person sends a reimbursement request to their competent fund (CNS or public sector fund) in order to be refunded for the portion of the costs covered by health insurance.
In order to be refunded for an invoice issued by a speech therapist, the invoice must:
- show the matricule number of the insured person, their name and surname as well as the number of the certificate of coverage ;
- be paid and receipted ;
- be submitted with the medical prescription and the certificate of coverage.
Coverage rate for acts and services by speech therapists is set at 88%, except for children and youngsters below the age of 18, who are entitled to coverage at 100% for all acts of speech therapy.