Keratoconus

Coverage and
reimbursement

Cost is a legitimate question, and it is rarely addressed clearly. This page sets out what Belgian compulsory health insurance covers in the monitoring and treatment of keratoconus, what it does not cover, and where to enquire about your own situation. It describes mechanisms, which change slowly, rather than amounts, which change every year.

How coverage works in Belgium

Three levels are superimposed, and confusing them is the first source of unpleasant surprises.

  • L’assurance obligatoire (compulsory health insurance) is the same for everyone. It reimburses the services listed in the nomenclature, under precise conditions. It is the foundation.
  • The supplementary benefits of your mutualité (health insurance fund) are added to it. They vary from one fund to another and according to the plan taken out: two patients in the same clinical situation may receive different amounts.
  • Any private insurance (hospital and/or medical), taken out privately or through your employer, comes in beyond that. It is usually this which covers the supplements.

Two notions then recur on every invoice:

  • the ticket modérateur, the share left for you to pay after compulsory insurance has intervened;
  • the doctor’s conventionnement status, which determines whether the official fee scale applies — a doctor who is non conventionné may charge fee supplements.

Consultations and examinations

Ophthalmology consultations and the examinations of the corneal assessment fall under compulsory insurance, with a ticket modérateur for you to pay.

Corneal imaging is covered in the context of keratoconus. It is performed at each visit, at a rhythm that follows that of monitoring: closer together when a change is suspected, more spaced out when stability is confirmed. It is the medical justification for the examination that underpins its coverage, not a fixed calendar.

Screening and diagnosis →

Keratoconus calls for examinations repeated over time, and it is that repetition which weighs more than any single examination.

Progression and monitoring →

Glasses and contact lenses

Keratoconus as such does not create an entitlement to these reimbursements. Compulsory insurance contributes to the cost of contact lenses in four situations, one of which covers most established keratoconus: irregular astigmatism that spectacle lenses cannot correct. The other three are a correction of at least six dioptres, a substantial difference in power between the two eyes, and the absence of the crystalline lens on one side.

In other words, it is not the name of the disease that creates the entitlement, but the nature of the astigmatism it produces — which explains why early keratoconus, still correctable with glasses, does not give access to it.

Keratoconus →

What is covered. Rigid lenses and specialised soft lenses alike fall within the scheme. Scleral lenses come under a specific category, also provided for: this matters, because they are often the ones that give the best tolerance in advanced forms.

Treating keratoconus →

What is not. Lenses bought online are excluded from reimbursement. Supply must go through an opticien agréé (approved optician).

The formalities. Two documents are to be sent to your mutualité: the prescription written by the ophthalmologist, and the attestation de délivrance (certificate of supply) that the optician draws up when handing over the lenses.

Renewal depends on the type of lens and on how your correction changes: a sufficient change in sphere or cylinder relative to the previous supply reopens the entitlement. In keratoconus that is progressing, this condition is often met — one of the rare occasions when the progression of the disease works in your favour administratively.

The amounts covered depend on the type of lens and are revised periodically. They are published by the INAMI, which updates them at source. Your optician will tell you the amount applicable to your situation before ordering.

Remboursement des lentilles de contact — INAMI (in French) ↗

Cross-linking

Cross-linking is not covered by compulsory insurance. It is not listed in the nomenclature: there is no code for this procedure, and no reimbursement is provided for it on that basis — nor for the product used during the procedure.

Corneal cross-linking →

The procedure is performed as a day case, without hospital admission. There are therefore neither accommodation charges nor room supplements.

Both eyes are not necessarily treated at the same time, and not always both: that depends on what monitoring shows on each side.

Progression and monitoring →

Three steps are worth taking beforehand:

  • ask your mutualité about its supplementary benefits: some contribute to procedures not reimbursed by compulsory insurance, under rules of their own;
  • ask your private medical insurer, if you have one, specifying that this is a therapeutic procedure and not surgery for convenience — the distinction often determines the answer;
  • request a written estimate before the procedure, which lets you submit your claims beforehand rather than afterwards.

Intracorneal segments

Two distinct costs overlap here, and it is useful to separate them.

The tissue itself is not sold. Corneal donation is unpaid in Belgium: no remuneration may be linked to the donation of an element of the human body. What you do not pay for is the tissue; what has a cost is its retrieval, its screening, its storage and its preparation by the tissue bank.

Intracorneal segments →

This logistics chain is covered by compulsory insurance, and the ticket modérateur is nil. The implanted tissue falls under the same framework as tissue intended for a corneal graft, and therefore benefits from the same arrangement.

The surgical procedure is also covered, within that same framework: a segment of corneal tissue implanted within the thickness of the cornea constitutes, strictly speaking, a lamellar graft limited to one sector.

A clarification that spares needless worry. The words greffe de cornée (corneal graft) may appear on your administrative documents or on your invoice. It does not mean that your cornea has been replaced: it reflects the regulatory framework applicable to the implanted tissue (corneal tissue has indeed been grafted onto your cornea, but without exchange). The procedure remains the one that was explained to you.

Said plainly

What coverage does not tell you

You will have noticed while reading the previous sections: the procedure that aims to stabilise the cornea is not reimbursed, whereas the one that aims to regularise its shape is.

This difference stems from the administrative framework, not from the value of the two procedures. A procedure is reimbursed when it is listed in the nomenclature; biological segments are, because the implanted tissue falls under an existing framework, while cross-linking and synthetic segments are not, because no code has been assigned to them. Neither says anything about the usefulness of the procedure in your situation.

The practical consequence deserves to be stated clearly: reimbursement does not determine the indication.

These two procedures do not answer the same question — one addresses the progression of the disease, the other a vision that has become insufficient. Choosing on the basis of what is reimbursed rather than what your eye needs would lead to a decision that makes no medical sense.

Cost is a real constraint, and it is legitimate to take it into account. It is discussed once the indication is established, not in its place.

Treating keratoconus →

What is not covered

  • Fee supplements charged by a doctor who is non conventionné.
  • Room supplements in the event of admission to a single room.
  • Lenses bought online, whatever your medical file.
  • The part of the lens fitting that goes beyond the provided-for intervention — and in keratoconus, fitting requires several trials and represents specialised work.
  • Second pairs, spare lenses and cleaning products.
  • Travel and time lost from work, far from negligible when monitoring is frequent.

The questions to ask, and of whom

  • Before a procedure, you may request a written estimate of what will be left for you to pay. It is a right, and the best way to avoid an unpleasant surprise.
  • Your mutualité is the only body that can tell you what entitlements your personal situation opens, supplementary benefits included. It is the first port of call, before the medical secretariat.
  • Your optician will tell you the price of the lenses, the expected reimbursement and the share that falls to you, before ordering.
  • The clinic secretariat can advise on the costs linked to hospital stay and admission.
  • Your hospital insurer, where applicable, often has to be notified before the procedure rather than afterwards.

On the reliability of this page

The conditions described here change — some every year, others as the nomenclature is revised. Only your mutualité and the competent INAMI department are authoritative.

We maintain this page because the absence of information is in itself a problem for the patients concerned. We cannot guarantee that it is accurate on the day you read it.

An estimate to request, or an indication to compare?

Get in touch

The questions patients ask most often

Frequently asked questions →
On this page