Dianne Vugts (49) from Vlijmen is going to war against her health insurer. She lives with an amputated leg and wants to run again after years of sitting still. This is only possible with a special sports prosthesis. But according to Interpolis/Achmea she doesn’t need it, because she can also practice other sports. She will go to court, in April she will face the health insurer.
Dianne struggled for more than ten years with severe pain due to untreated ankle osteoarthritis and chronic pain syndrome. Before that, she exercised a lot and loved running.
The amputation of her leg a year and a half ago came as a relief. Her pain disappeared, she saw opportunities to exercise again. “I had gained weight, I was depressed, but after that surgery I wanted to do what I had been missing for so long!”
A year ago she became acquainted with a sports blade during a loan program for sports aids. She was allowed to try a custom-made blade for six months. And it went very well. But because the prosthesis had been borrowed, she had to return it.
She now wants to have her own sports blade and called her health insurer. Such a sports prosthesis costs at least 7,000 euros. But the insurer only reimburses a prosthesis for everyday life. “According to the health insurer, I can do enough with this prosthesis, I can go shopping and I can go to work. You have to deal with that.”
The health insurer pointed to the municipality, where they reimburse an amount from the WMO (Social Support Act). But that wasn’t enough either.
“On my LinkedIn I posted photos of hydrotherapy. The health insurer sees this as swimming training and thinks I can go swimming. They have no idea how annoying it is to hop to the edge of a pool with a stump. How you are stared at. I think I have the right to choose which sport I practice.”
Dianne is willing to contribute to a magazine herself, she is willing to pay more health insurance premiums if necessary. But it bothers her that a request is rejected while the health insurer has never bothered to hear her motivation in person.
That is also the reason that Dianne has filed a case. She hopes eventually for a counter where people with disabilities can go for a sports prosthesis, so that they no longer have to travel from cupboard to wall.
“I know it’s going to be a long haul but if I don’t do anything, nothing will happen. Sports yields so much health gain, a health insurer should applaud that, right?”
Interpolis/Achmea is familiar with the story and confirms that a case will be filed in April. Because they will soon be in court with this, they cannot comment further on the case. The health insurer says that the government determines the composition of the basic package and that they follow the guidelines from the Health Insurance Act.
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