When your back gives out: What health insurance covers for osteopathy, physiotherapy, and chiropractic care
A long day at the laptop, an awkward move while carrying groceries, or a fall on the ski slopes: back pain is one of the most common complaints in Switzerland. According to the Back Report by the Swiss League against Rheumatism, around half of the population suffers from it several times a month. Before your back gives out, it is worth checking your insurance coverage. Whether health insurance pays for osteopathy, physiotherapy, or chiropractic care depends heavily on whether you have only basic insurance or also supplementary insurance.
An overview of the three methods
At first glance, the three disciplines are similar: they all treat musculoskeletal complaints. However, their training, approach, and typical areas of application differ significantly.
Physiotherapy focuses on targeted exercises, manual techniques, and physical measures such as heat or electrotherapy. The goal is to restore mobility, strength, and posture. It is often used for long-term complaints or after injuries and surgeries.
Chiropractic care is a university-level medical profession in Switzerland. Chiropractors study medicine with a focus on chiropractic and are authorized to diagnose and treat musculoskeletal complaints themselves. Many patients suffer from acute lower back or neck pain.
Osteopathy is a manual method with a holistic approach. Osteopathy is frequently sought for back and neck tension, headaches, or complaints resulting from incorrect physical strain. Anyone practicing independently requires a Master’s in Osteopathy or the former intercantonal diploma from the Swiss Conference of Cantonal Health Directors (GDK), as well as a cantonal professional license.
When basic insurance pays
Physiotherapy: covered, but only with a prescription
Basic insurance covers physiotherapy if a doctor has prescribed it. Chiropractors can also prescribe physiotherapy. A prescription is valid for a maximum of nine sessions, and the first treatment must begin within five weeks. If more treatments are necessary, a new prescription must be issued. After four prescriptions—i.e., 36 sessions—a medical report to the health insurance company’s medical examiner is required for continuation. Furthermore, the physiotherapist must be accredited for basic insurance.
Chiropractic care: direct access
Because chiropractic care is a medical profession, chiropractors bill directly through basic insurance. If you have a free choice of doctor, you can contact a practice directly without a referral. If you have chosen a family doctor, HMO, or Telmed model, you usually need to contact your family doctor’s practice, your HMO center, or the telemedicine advisory service first.
Osteopathy: not a basic insurance benefit
Osteopathy is not part of the basic insurance benefit catalog. Health insurance therefore only contributes to osteopathy if you have the appropriate supplementary insurance. Otherwise, you bear the costs yourself.
Even with coverage, a personal contribution remains
Where basic insurance pays, the deductible and retention fee apply. Anyone who has chosen a deductible of 2,500 francs and has few other healthcare costs in the same year will often pay for a series of physiotherapy sessions themselves, even though they are fundamentally covered. The situation is different after an accident, such as while skiing: anyone who works at least eight hours per week for the same employer is covered by their employer’s accident insurance, without a deductible or retention fee. You can read more about this in our article on accident coverage.
Important: Even after an accident, a medical prescription is required for physiotherapy. Accident insurance generally does not cover osteopathy.
Where costs arise for the insured
Even for treatments that are fundamentally covered, there are situations in which the insured must bear the costs themselves.
In physiotherapy, this primarily concerns sessions without a valid prescription. This can happen faster than you think: if the first session does not begin within five weeks of the prescription being issued, it expires. Especially with fully booked practices, it is therefore worth making an appointment immediately. You also pay for the treatment yourself if the nine sessions have been used up and the new prescription is still missing. The same applies to treatments in a practice without health insurance accreditation.
During ongoing therapy, targeted training on equipment can also be part of the prescribed physiotherapy, known as medical training therapy (MTT). However, once the therapy is completed, basic insurance no longer pays for preventive offers such as back exercises, Pilates, or fitness training, even if they help to avoid a relapse.
In chiropractic care, basic insurance only covers the actual chiropractic treatment. If practices offer additional services such as massages that are not part of the benefit catalog, these must be paid for privately. Furthermore, preventive treatments without current complaints are not covered.
In osteopathy, you bear the entire cost without supplementary insurance. A session can cost up to 200 francs depending on the region and practice. Since a treatment usually comprises several sessions, high costs can quickly accumulate.
How supplementary insurance can bridge the gaps
Part of these costs can be covered by outpatient supplementary insurance. What they cover differs depending on the provider and product.
Many products contribute to osteopathy, often through the complementary medicine section. A percentage of the costs with an annual maximum is common. Frequently, several treatment methods share this annual budget. A prerequisite is that the osteopath is recognized by the insurance company. Some insurers also set maximum rates per treatment time or require a medical prescription. You can find out what generally needs to be considered for complementary medicine treatments in our article on complementary medicine.
Depending on the product, other services outside of basic insurance, such as medical massages, are also covered by outpatient supplementary insurance.
For prevention, many outpatient supplementary insurance plans also provide annual contributions toward health courses or fitness memberships. For example, if you stick with back exercises, Pilates, or targeted strength training after physiotherapy, you can recover part of the costs for prevention this way.
It pays to act in time
Anyone considering supplementary insurance should not wait until their back hurts. Supplementary insurance is subject to the Insurance Contract Act, so the insurance company will check your state of health before concluding the contract. If you are already receiving treatment for back complaints, you must expect that these specific issues will be excluded from coverage. Depending on the product, a waiting period may also apply before benefits can be claimed.
The easiest way to find out if your current policy includes osteopathy, massages, or prevention courses is through a consultation. The advisors at simply take the time for this free of charge and without obligation, either in person in Gümligen or conveniently via video consultation.
Fact sheet on outpatient supplementary insurance 