Applying for reimbursement of a prosthesis from Belgian health insurance

A frequently asked question at the Amputee Care Centre in Genk is whether a prosthesis will be reimbursed or covered by the Belgian health insurance system. The National Institute for Sickness and Disability Insurance (NIHDI) stipulates that your mutual insurance company will reimburse or reimburse your leg prosthesis or arm prosthesis, according to Belgian nomenclature legislation. Other insurances, such as after an accident, also reimburse the cost of your prosthesis, in part or in full.

At the Amputee Care Centre, we will tell you everything you need to know about reimbursement by the National Health Service, accident insurance or other insurance and how we can help you. We will help you apply for a new prosthesis or for a check-up, maintenance and repair of your current prosthesis.

Opt for a personal approach. Visit us for an informal introductory meeting. We will gladly help you apply for a new prosthesis: hip prosthesis, upper leg prosthesis, lower leg prosthesis, arm prosthesis, hand or finger prosthesis.

Leg and arm prostheses: how is reimbursement calculated in Belgium?

The amounts in the nomenclature cover part or sometimes all of the cost of the prosthesis, depending on the type and situation of the patient.

The Amputee Care Team by Spronken has more than 60 years of experience in assisting prosthetic patients of any age. In consultation with the doctor and paramedical team, we look for a prosthesis that suits you and ensures that you can live your life to the fullest. We also help you with applications for reimbursement from the National Health Service or insurance companies, so that you enjoy maximum intervention or reimbursement.

In Belgium, reimbursement of prostheses for the upper or lower limb is regulated through the NIHDI and the specific rules for reimbursement or intervention prostheses to replace a limb are complex and depend on several factors, such as the amputation level, the type of prosthesis, the type of disability and the patient's needs or activity level. The patient's age is also taken into account. Babies, children and teenagers are more likely to be entitled to a renewal than adults.

Conditions for reimbursement of an arm prosthesis or leg prosthesis in Belgium.

There are specific conditions to qualify for reimbursement of prostheses in Belgium. For example, you need a prescription from a doctor-specialist (e.g. an orthopaedic surgeon or rehabilitation doctor).

The prosthesis wearer enters into a contract with an approved supplier, such as the Amputee Care Centre by Spronken. The prosthesis supplier must be recognised by the NIHDI. Reimbursement is only possible with approved prosthesis suppliers.

In each case, an approval procedure is required in which the RIZIV must approve the type of prosthesis and the reimbursement based on the patient's medical file. Our team will help you with the approval procedure and the application for your new prosthesis. We bill directly to your National Health Service/RIZIV and you only pay the co-payment, if applicable.

Own contribution and intervention for a prosthesis in Belgium

The intervention and reimbursement rules for prostheses are complex and depend partly on the social situation of the prosthesis wearer. Even with reimbursement or intervention, the patient sometimes has to pay a co-payment. The intervention varies widely, depending on the type of prosthesis and insurance status. For simple prostheses, the co-payment can be relatively low, while complex and advanced leg prostheses, arm prostheses, hand prostheses and finger prostheses often require a larger co-payment.

Is a leg prosthesis reimbursed in Belgium?

Good news, because a basic leg prosthesis is fully or mostly reimbursed in Belgium by the National Health Service through the NIHDI. A basic prosthesis is usually fully covered, without a surcharge, if you meet the conditions of the NIHDI nomenclature and you choose a good prosthetist, who has a transparent price setting.

Some facts about leg prostheses

• Basic prostheses: A standard leg prosthesis is often fully reimbursed by the mutual insurance company if it is medically necessary for your mobility. So most people do not have to pay a co-payment for a basic leg prosthesis. At the Amputee Care Centre, we make fully customised prostheses. Even for a basic prosthesis (hip prosthesis, upper leg prosthesis or lower leg prosthesis), you can therefore count on a comfortable and functional leg prosthesis, with no co-payment.
• Advanced prostheses: If you opt for a leg prosthesis with more advanced technology, such as an advanced prosthetic foot or an electronic knee, there may be additional costs. The amount of this contribution depends on the technology used and the approval by your mutual insurance company. At Amputee Care Centre, we will help you with the application to get as much reimbursement as possible.
• Reimbursement of the electronic prosthetic knee: This high-tech knee has been reimbursed since the beginning of 2021. However, you need proof that such a prosthetic knee adds value to your life. Only a multidisciplinary team consisting of a physician-specialist, physiotherapist, occupational therapist and prosthetist can provide this proof. The renewal period remains in force. You can apply for an electronic knee only when you are entitled to a renewal. The Amputee Care Centre team will help you with the application.
• Reimbursement of sports prostheses: sports prostheses are not reimbursed by the National Health Service in Belgium. Are you interested in this? Then we will be happy to tell you more about it on our page: What does a sports prosthesis cost?
• Leg prosthesis maintenance or repair: annual maintenance of your prosthesis is essential for both comfort and longevity. At Amputee Care Centre, we offer free annual maintenance with free gait or gait analysis. This way, we ensure that your leg prosthesis continues to function optimally. Minor repairs and adjustments are also carried out, with no need to worry about the cost.

Arm, hand and finger prostheses: how is reimbursement calculated in Belgium?

Your prosthetist will help you apply for reimbursement and intervention. In Belgium, arm, hand and finger prostheses are reimbursed according to similar rules as leg prostheses. Arm prostheses, hand prostheses and finger prostheses are fully or partially reimbursed via the RIZIV. The intervention depends on the amputee's medical and social situation. A doctor-specialist, such as a vascular surgeon, orthopaedic surgeon, rehabilitation doctor, physical physician must prescribe the arm prosthesis, and the health insurance fund/ the NIHDI approves the application.

Like leg prostheses, arm prostheses, hand prostheses and finger prostheses also have a fixed lifespan, after which renewal can take place. Here too, the age of the amputee plays a role. Arm prostheses for children have a shorter renewal period than prostheses for adults. Functional arm prostheses, such as myo-electric arm and hand prostheses and bionic arm prostheses, have a higher payback than cosmetic arm prostheses. A cosmetic arm prosthesis can often be made at hospital rates. People with functional arm prostheses do sometimes pay a co-payment, depending on the technology and type of prosthesis.

Which arm prosthesis is reimbursed?

Just like leg prostheses, arm prostheses in Belgium are fully or partially reimbursed or reimbursed by your mutual insurance company. The amount of reimbursement here does depend on the type of arm prosthesis, hand prosthesis or finger prosthesis you need:

• Basic arm prosthesis: A simple mechanical or cosmetic arm prosthesis is fully reimbursed if there is a medical need for it. Thus, you usually do not have to pay a co-payment for this type of arm, hand or finger prosthesis. Reimbursement for silicone arm prostheses is limited due to their high cost. A supplement often has to be paid for these.
• Myo-electric and bionic arm prostheses: For more advanced prostheses that work with electrical signals from your muscles, partial reimbursement may be possible. These arm prostheses are a lot more expensive and offer more functionalities. However, the mutual insurance company can only cover part of the cost of these. The remaining costs are at your own expense. These costs depend on the type of prostheses and the options you choose. We at Amputee Care Centre always make a customised quote for this.
• Arm prosthesis maintenance and repairs: Annual maintenance is also crucial for arm prostheses to keep them in good condition. At Amputee Care Center, you can always contact us for free maintenance.

Children's prostheses: how is reimbursement calculated in Belgium?

In Belgium, children's prostheses are also partially or fully reimbursed, with specific rules depending on the type of prosthesis, the child's age and growth. Shorter renewal periods apply to children and teenagers under 18, given their rapid growth. A replacement or renewal is possible every 2 to 3 years. However, advanced children's prostheses, such as the Hero arm, a bionic arm prosthesis, can be much more expensive than the intervention of the National Health Service. Nevertheless, many parents choose a Hero bionic prosthetic arm for their child. The benefits of this type of prosthesis are great, but this type of prosthesis is unfortunately not financially available to every child.

How can Amputee Care Centre help you?

Buying or getting a prosthesis is an important decision as an amputee. Not only financially, but also emotionally and functionally. We are happy to help you at the Amputee Care Center prosthesis centre in Genk. ACC (by Spronken) is a recognised and official service provider for prostheses.We will gladly guide you through the entire process and can even apply for reimbursement from the RIZIV and your mutual insurance company for you. We make sure you have the right documents and help you submit your applications, and we arrange direct (third-party) payment with your health insurer. So you don't have to think about this and can just enjoy your new prosthesis!

Based on your needs and lifestyle, we advise which prosthesis suits you best. Sometimes this is a basic prosthesis that is fully reimbursed, but we will also give you honest advice on its limitation if you want more options. When an advanced prosthesis better suits your needs, a co-payment is therefore necessary. Therefore, this may not be suitable for everyone.

However, our goal is to let you walk out with a smile again!We therefore fully customise every prosthesis.So you enjoy a comfortable prosthesis that fits your body perfectly. We also make sure that your prosthesis continues to function well and remain comfortable during our free annual maintenance. We keep your prosthesis in top condition and fix any problems quickly.

Make a no-obligation appointment at ACC

At Amputee Care Centre, we are happy to help you through the entire process of getting a new denture. From choosing the right prosthesis to maintenance and from emotional support to applying for reimbursement, intervention and fees. With us, you will find everything under one roof in Genk.

As a recognised service provider of dentures, we are ready to support you every step of the way. Do you have questions about costs, insurance, an amputation or the maintenance of your prosthesis? Feel free to visit us for an informal chat and a cup of coffee.

Together, we will make sure you go through life comfortably and confidently again!