The care performance model starting 1-1-2022 ‘Zorgprestatiemodel’
Charging for mental healthcare
In ‘het zorgprestatiemodel’, mental health treatments are paid for as separate care services.
The system for calculating and reimbursing healthcare costs regulates what the treatment may cost and how your care provider must charge for it. It is not about the type of treatment you get or how you get it.
Rate: The healthcare provider bases the rate on the time that was set aside for you in the agenda, even if the consultation actually was a little longer or shorter.
If you are in touch with your healthcare provider several times in one day by email or a chat session, then this may be invoiced as one consultation.
Your treatment in mental healthcare consists of ‘care services’. The care services are listed on the invoice that the healthcare provider sends to you or your healthcare insurer.
This way, it is clear which treatment you or your health insurance company will pay for.
The treatment that you get will not change. But it will be easier for you to check the bill. You can see exactly who you spoke to during a consultation and how much time was charged. The bill will also be sent sooner, for instance in a month’s time.
Type of healthcare required ‘Zorgvraagtypering’
In the old system, it was the diagnosis that often determined the costs of treatment. This is no longer the case in the new way of charging. Your healthcare provider records the type of care required in ‘het zorgprestatiemodel’. The type of care provides information about the care you require. Your healthcare provider can use it when drawing up a treatment plan, for instance.
The type of care does not determine the price of the treatment.
Instead it is the care services that you are given that determine the price.
During your treatment, your healthcare provider may redefine the type of care required to make the change clear. The type of care required is stated on the bill.
There are 8 types of healthcare. Type 1 to 4 (and sometimes 5) are equal to generalist basic mental health (gb-ggz). Types 5-8 are equal to specialized mental health care.
To receive reimbursement of costs from your insurance company, you will need a reference letter from your general practitioner.
Insurance companies want the referrals to meet certain requirements.
You can check whether your referral meets the requirements, by studying the information mentioned below.
The following needs to be mentioned in your referral letter:
• Is there a reference to either BG-GGZ or S-GGZ?
• What is the hypothesis about the diagnosis or which is the disorder suspected by the general practitioner that is registered in DSM 5 and that meets the requirements for eligibility for reimbursement?
• Is the date of referral mentioned?
• Is there an official stamp and signature of the general practitioner?
You will find some examples of a referral letter of either B-GGZ or S-GGZ down below:
• example referral letter ‘generalistische basis GGZ
• example referral letter ‘specialistische GGZ’
To sign up, use the registration form at this website. You will also need a referral letter from your general practitioner for both signing up and to be able to receive reimbursement from your insurance company. After both the referral and the registration form are received, you will be contacted. In this conversation, there will be discussed whether it is necessary to provide more information. In case of a waiting list, you will be informed about the length of the waiting time. Information about the waiting list is under the head ‘waiting period’. You can leave a voicemail when you call. Please leave both your name and phone number in this voicemail and your call will be answered.
During the first appointment, I am obliged to ask for an identification so I can verify whether the information matches your social service number (BSN). The type and number of the identity certificate are administrated. Before the start of therapy, we must first determine what the problem is. During this first meeting, (also known as the interview) we will assess whether the problem can be treated with an appropriate treatment offer within our practice.
When this is possible, there will be more appointments during which we will explore the problems at a deeper level and study whether they can be linked to your past/background. Also, we will ask you to fill in some questionnaires. During treatment and at the end of treatment some questionnaires will be filled in too. So we both can study how treatment helps you and how development evolves. We study whether adjustments are needed and we study the effect of the treatment. This is called the Routine Outcome Measurement (ROM).
Of course, I would like to know what you have tried before to fix your problems and what treatments you have had. So we learn to know what benefitted you and what treatment we should or should not start. I would also like to know what your ideas and expectations are regarding change in your problems and situation. Based on these data we will formulate a preliminary diagnosis.
In an advisory interview, we will discuss the possibilities for psychotherapy and I will do a proposition regarding the type of treatment. I will broadly explain the contents of this treatment. Based on this information, you can decide whether or not you choose this particular chosen treatment. It would be wise to take your time before deciding. Perhaps you need more information or you might have more questions regarding the proposed treatment. When it is not possible to provide the desired therapy/treatment, together we can search for another practitioner or mental health institution.
During the introductory meetings, I can get an impression of your resilience and personal circumstances. This is needed to study whether psychotherapy can offer the best treatment, and if so, what is the best frame of reference to use. Psychotherapy can evoke strong feelings of anxiety and tension. If you experienced large changes or disruptions in your life, a psychotherapeutic treatment might not be the right treatment offer at this particular time.
If this is so, we can discuss other treatment possibilities. At a later, more suitable, moment a psychotherapeutic approach can be indicated.
If treatment is possible in my practice, the next step will be to draft and sign a diagnosis-treatment plan-treatment agreement (DBB). Both the client and myself sign this agreement. This agreement meets the requirements, stated by law about the agreement for the healthcare treatment ‘wet op de geneeskundige behandelovereenkomst (WGBO), which was implemented on April 1st, 1995. This law reinforces the position of the client in relation to the psychologists/psychiatrists. The law states the following: the right to receive information, the requirement of permission to give the treatment, the duty to keep a medical file, the right to look into this file and confidentiality of this medical information.
You will receive a copy of this agreement. We also register the evaluation moments (ROM) in this treatment plan. If, based on the findings of the evaluation, an adaptation is needed, a new treatment plan will also be made and signed and you will also receive a copy of that plan.
A psychotherapeutic treatment: there will be weekly appointments at a fixed day and time.
Partner-relationship therapy: there will be either weekly appointments or appointments every other week.