When visiting a bonesetter's clinic or osteopathic clinic
You might use a bonesetter's clinic or osteopathic clinic to treat a sprain or bruise. However, the extent of cases in which you can use health insurance at such clinics is very limited, since a bonesetter's clinic or osteopathic clinic is not an insurance medical care facility and the judotherapists who provide such care are not physicians.
Cases in which you can use health insurance
Only the following clearly external (traumatic) injuries are covered by health insurance.
- * Conditions due to internal (medical) disorder are not covered by health insurance.
- * Any injury must not have become chronic to be covered by health insurance.
●Bone fractures, dislocations
- * A doctor's consent is required except in cases in which the treatment is provided as first aid.
●Bruises, sprains, contusions (torn muscles, etc.)
Cases in which you cannot use health insurance
Since you cannot use health insurance in the following cases, you must cover the entire cost of treatment yourself.
Case 1You are treated at a neighborhood osteopathic clinic for stiff shoulders due to fatigue from daily activities.You cannot use health insurance for medical treatment of mere stiff shoulders or muscular fatigue.
Case 2After the weeding of the garden, because the back pain comes from that evening, she received the treatment in the next day Osteopathic Council.Health insurance can not be used to the stiff back pain that occur in everyday life.
Case 3You are treated at an osteopathic clinic for a knee injury dating back from several years ago that flared up again.You cannot use health insurance for cases such as aftereffects of past injuries or traffic accidents.
Case 4You visit an osteopathic clinic in the hopes of speeding recovery from an injury for which you are currently being treated at a medical care institution.You cannot use health insurance at the osteopathic clinic if you are being treated for the same injury at a medical care institution.
Case 5You repeatedly visit an osteopathic clinic to treat long-term joint pain.You cannot use health insurance for treatment with no specific aim and no signs of improvement over extended periods.
Case 6You visit an osteopathic clinic for pain attributable to conditions like neuralgia or rheumatism.You cannot use health insurance to treat pain or other conditions caused by an illness or injury for which treatment at a medical care institution is more appropriate.
Be sure to check the specific information concerning your treatment
In principle, the costs for treatment at an osteopathic clinic or a bonesetter's clinic are handled as “Medical Care Expenses” for which the patient must pay the entire amount him or herself, then apply to the Health Insurance Society for reimbursement of 70% of the amount. However, for convenience, a judotherapist working at an osteopathic clinic or a bonesetter's clinic that has concluded an agreement with the prefecture may apply for direct payment of medical care expenses. In such cases, you will simply pay a copayment of 30% in principle, just like at an insurance medical care facility.
Even if the judotherapist applies directly for payment, note that you must sign or affix your seal to “the Application Form for Medical Care Expenses”. When requesting payment in this way, be sure to check to confirm that information (e.g., cause and location of the injury) is correct. (Do not sign blank applications.)
Be sure to obtain a receipt
Osteopathic clinics and bonesetter's clinics are required to issue receipts free of charge. Always obtain a receipt, just as if you were undergoing treatment at a medical care institution.
While the receipt will ideally provide detailed indications of the amount of each treatment item to allow future review of treatment specifics, a detailed receipt may cost extra in certain cases.
For insured persons who received treatment at osteopathic clinics or orthopedic clinics with their health insurance cards, we may inquire about the details of the treatment, post-treatment follow-up, and causes of injury, etc. at a later date. The MSD Health Insurance Society outsources such inquiry making operations to the following specialist company. The aim of this inquiry is to check for fraudulent health insurance reimbursement claims and to confirm that health insurance is being used properly. Therefore, for those of you who have received an inquiry document, your cooperation is greatly appreciated.
[Subcontractors] Gulliver International (Ltd.)
Yubinbango103-0025, Chuo-ku, Tokyo Nihonbashi Kayabacho 3-4-2
The scope of health insurance coverage
Acupuncture / moxibustion treatment will be covered by your health insurance; provided, however, that this will be limited to cases where you have any one of the following injuries and diseases and there is no other proper alternative treatment offered by a physician (e.g., in the event where the insured person received treatment at a medical institution, but it had no effect) and the physician has given you permission to undergo the acupuncture / moxibustion treatment.
*The physician’s written consent needs to be attached to the initial application.
● Neuralgia ● Rheumatism ● Frozen shoulder ● Cervico-omo-brachial syndrome
● Lower back pain ●Aftereffects of cervical spine sprain
*Bone fracture and bone dislocation are not covered by your health insurance unless the physician’s permission is obtained, except in the case of emergency treatment.
(1) A combination of treatment at a clinic for acupuncture / moxibustion and at a medical institution is not covered by health insurance.
(2) The physician’s permission needs to be obtained every six months.
(3) All medical treatment expenses need to be paid by the insured person up front. (The expenses will be reimbursed upon filing a reimbursement claim.)
The scope of health insurance coverage
Anma/massage is covered by health insurance only when you have experienced muscular paralysis/arthrogryposis, etc., and a physician has approved the fact that anma/massage treatment is necessary to increase range of motion and strengthen muscle to improve symptoms. Therefore, massage treatment aimed at achieving recovery from fatigue and ease tension is not covered by health insurance.
*The physician’s written approval needs to be attached to the initial application.
(1) The physician’s approval needs to be obtained every six months. Treatment without your physician’s approval will not be covered by health insurance.
(2) All medical treatment expenses need to be paid by the insured person up front. (The expenses will be reimbursed upon filing a reimbursement claim.)
The method of filing a reimbursement claim for medical expenses for acupuncture, moxibustion, anma and massage therapy
Please send the following documents listed in I. through IV. to Payroll Inc .
I. Application Form for Reimbursement of Medical Expenses * This form is available for download from the website of the Health Insurance Society.
II. Written permission from an orthopedic surgeon (health insurance physician), etc.
III. Receipt issued by treatment clinics of acupuncture and moxibustion, etc. (original copy)
IV. Application Form for Reimbursement of Medical Expenses of treatment clinics of acupuncture and moxibustion, etc. (original copy)
*If you have undergone treatment more than once in a month, you can apply for reimbursement for all of your treatment sessions by filing the application form listed above in I. once. However, you need to attach receipts for all the treatment sessions.
The written permission can be issued only by the attending physician who has continuously been providing treatment for the said disease; provided, however, that this will not apply when the attending physician’s written consent cannot be obtained due to inevitable reasons on the part of the physician. The written consent of a physician other than the attending physician will be accepted only if the MSD Health Insurance Society finds the inevitable reasons therefor to be valid.