Insurer report after 30 psychotherapy sessions in Switzerland

The insurer report after 30 sessions is the request that allows psychotherapy delivered by a psychologist-psychotherapist on medical prescription in Switzerland to continue under compulsory health insurance. It is drawn up by the prescribing physician, contains a proposal to extend therapy, is sent to the insurer's medical adviser (médecin-conseil) under the procedure set by the Health Insurance Benefits Ordinance (OPAS/KLV), and relies on the account of the therapy provided by the psychotherapist.

This article sets out what the OPAS, the Federal Office of Public Health (FOPH), one insurer (CSS) and the psychiatry societies say, then shows how to prepare your part of the report from your session notes.

How does the prescription model work since July 2022?

Since 1 July 2022, psychotherapy delivered by psychologist-psychotherapists is covered by compulsory health insurance when a physician prescribes it. This model replaced the former delegation model.

Under article 11b, paragraph 1, of the OPAS, an ordinary prescription is reserved for physicians holding a federal (or recognised foreign) postgraduate title in general internal medicine, paediatrics, psychiatry and psychotherapy, child and adolescent psychiatry and psychotherapy, or the interdisciplinary diploma in psychosomatic and psychosocial medicine.

There is also a prescription for crisis intervention or short-term therapy, in cases of serious illness, a new diagnosis or a life-threatening situation. The OPAS limits coverage to a maximum of 10 sessions (article 11b, paragraph 4). According to the FOPH, any physician with a federal postgraduate title can issue it, once only. Further therapy then requires an ordinary prescription.

What happens after 15 sessions?

A prescription covers at most 15 diagnostic and therapeutic sessions. For a new prescription of up to 15 more sessions, the FOPH states that an exchange of information between the prescribing physician and the psychologist-psychotherapist is required.

The OPAS goes further (article 11b, paragraph 2). Before the prescribed number of sessions runs out, psychologist-psychotherapists send a report to the physician who prescribes the therapy. The text sets no format for this report. We recommend a short written letter, which stays in the file and will serve as the basis for the 30-session report. Our psychologist letter to GP template can be a starting point.

What happens after 30 sessions?

Article 11b, paragraph 3, of the OPAS (SR 832.112.31) provides that if psychotherapy is to continue at the insurer's expense after 30 sessions, the procedure of article 3b applies by analogy. The physician who prescribes the therapy writes a report with an extension proposal. The FOPH speaks of a prior guarantee of cost coverage by the insurer.

Article 3b governs the continuation of psychotherapy after 40 sessions. Applied by analogy, it provides that the report is sent in good time to the insurer's medical adviser. The report states the type of illness, the kind, setting, course and results of treatment, and a proposal to extend therapy stating its aim, setting and likely duration. The medical adviser reviews the report and recommends that the insurer either continue coverage, stating the duration until the next report, or stop it.

According to the FOPH, crisis intervention sessions count towards this total. For example, 10 crisis sessions followed by 20 sessions on ordinary prescription already reach the 30-session threshold.

To be safe, we recommend waiting for the insurer's answer before the 31st session, or discussing it openly with the patient.

Who writes the insurer report and who receives it?

The OPAS is clear, and the FOPH confirms it. The report containing the extension proposal is drawn up by the physician who prescribes the therapy. By analogy with article 3b, it goes to the insurer's medical adviser. The 2023 position paper of the psychiatry societies also describes it as written for the insurer's medical adviser service. CSS, for example, asks for the form to be sent to its medical adviser service.

The psychotherapist remains central. In the CSS form, the first part is the psychotherapist's report, which must be fully completed and signed before the specialist physician can assess the case. The OPAS does not say who posts the complete CSS form. Agree with the prescribing physician on who sends what, and when.

Is a case assessment by a psychiatrist required?

It depends on the prescriber. When the prescription comes from a physician with a postgraduate title in general internal medicine or paediatrics, article 11b, paragraph 3bis, of the OPAS requires a case assessment by a specialist in psychiatry and psychotherapy, or in child and adolescent psychiatry and psychotherapy, to be attached to the report. The FOPH adds that, depending on the patient's vulnerability, this assessment may also be carried out on the basis of the file.

The OPAS requires it only for those two titles. The FOPH states that no additional assessment is needed if the prescriber is a psychiatrist (adult, or child and adolescent) or holds the interdisciplinary diploma in psychosomatic and psychosocial medicine.

In their September 2023 position paper, the Swiss psychiatry societies (SSPP, SSPPEA and SMHC) restate the purpose of this assessment. It checks whether the diagnosis and indications are still correct and identifies physical causes and interactions. They ask psychologist-psychotherapists and prescribing family doctors to arrange it actively and early enough.

What does the case assessment request form contain?

The OPAS sets the content of the report, not a form. CSS publishes a French form titled « Demande concernant la poursuite de la psychothérapie psychologique après la 30e séance » (request to continue psychological psychotherapy after the 30th session), listed on its site as the « Demande d'évaluation du cas » (case assessment request). Its preamble refers to article 11b OPAS. It has three sheets.

• Sheet 1, cover page. Details of the prescribing physician (RCC/ZSR or GLN, qualifications, signature and stamp) and of the patient.
• Sheet 2, psychotherapist's report. History and symptoms at the start of therapy, diagnostic assessment with ICD code, previous therapies, type and setting of current therapy, course so far, indication for continuing and goals, proposal for what comes next (frequency, likely duration, prognosis).
• Sheet 3, assessment by a specialist physician. Whether the patient was examined, diagnosis, indication, opinion on the course and on the proposal.

Other insurers may have their own document. Check with the patient's insurer which form it expects.

Is there a deadline for the request?

The OPAS sets no figure for sending the report. By analogy with article 3b, it must reach the medical adviser in good time (« à temps »). The figure in the text concerns the answer. The insurer tells the insured person, with a copy to the treating physician, within 15 working days of the medical adviser receiving the report, whether it will keep covering the psychotherapy and for how long.

A psychiatric assessment may require an appointment, and that answer time has to be allowed for. We therefore recommend starting the process several sessions before the 30th.

How do you prepare your part of the report from your session notes?

The 30-session report draws on what you have noted since the first session. Here is how to fill each section of the CSS form from your notes.

History and symptoms at the start of therapy

Go back to your notes from the first sessions: reason for referral, symptoms, impact on work, family life and sleep. The form asks for a detailed description in the first report and a brief summary in later ones.

Diagnosis and previous therapies

Give the diagnosis with its ICD code, consistent with the one agreed with the prescribing physician, and note any change. List any known previous treatments.

Type and setting of therapy

State the approach (CBT, systemic, psychodynamic, EMDR…), the setting (individual, couple, family, group) and the actual frequency of sessions.

Course, indication for continuing and goals

We recommend giving this section the most care, as it carries the extension request. Restate the goals set at the start, what has changed, what remains difficult and why continuing is indicated. Favour dated, observable facts over a general impression.

Proposal for what comes next

Propose a frequency, a likely duration and a prognosis, tied to the remaining goals.

If your notes follow a stable structure, such as the one described in our article on session notes for psychologists, each section can be filled by reading the file rather than piecing together 30 sessions.

What should, and should not, go into the report?

The report passes through the prescribing physician, sometimes a psychiatrist, then the medical adviser. By analogy with article 3b, paragraph 2, of the OPAS, it may only contain the data the insurer needs to assess its duty to cover the costs. Leave out private details unrelated to the indication and long quotations from the patient. We also recommend explaining the process and the content of the report to the patient before it is sent.

How does Delta help you prepare this report?

Delta does not fill in or send the insurer's form. It works upstream, on the file.

During the session, Delta transcribes what is said. You can also dictate your observations after the session and add written notes. Delta then generates the session report (short summary, detailed summary, topics for next session) in line with your approach, and updates the patient record with a summary of the therapy and tracked goals. At the 15th or 30th session, you find the whole course of therapy in one place, which helps you write your part of the report yourself.

Delta also drafts letters and reports suited to your profession, for example a letter to the prescribing physician after 15 sessions, which you review and adjust before sending. Examples are in our clinical document templates.

Data is hosted in France by an HDS-certified host and no audio file is kept. For an overview, read What is Delta?, and for record keeping in general, our end-of-therapy summary template.

Sources

• Health Insurance Benefits Ordinance (OPAS/KLV, SR 832.112.31), articles 3b and 11b, fedlex (in French)
• FOPH (OFSP), New regulation of psychotherapy delivered by psychologists from 1 July 2022 (in French)
• CSS, Psychotherapy delivered by psychologists, provider page (in French)
• CSS, Request to continue psychological psychotherapy after the 30th session, form version 1.0 (in French)
• SSPP, SSPPEA and SMHC, Case assessment is absolutely necessary, position paper (in French), September 2023