Reimbursement of the costs

The care performance model ‘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.

‘Het zorgprestatiemodel’
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’

Care not reimbursed by the health insurer but at your own expense
Certain forms of care or treatment of certain problems do not (any longer) fall within the scope of the Health Insurance Act and are therefore not eligible for reimbursement. For example, treatment of relationship problems that are not related to psychological and/or psychiatric problems does not fall under insured care, even though the problems can be serious and treatment is considered desirable. Treatment of serious problems in the context of grief without depression is not reimbursed. Problems at work, or other specific adjustment disorders that can be associated with many complaints, such as sadness and less ability to function, are also not covered by the health insurance law. You may still want to be eligible for treatment.
Care not reimbursed by the health insurer will not be given in this practice.

Reimbursement basic insurance
The percentage of reimbursement for your treatment depends on the following:
1. The insurance policy that you have taken out with your health insurer.
This can be a restitution (100%) refund policy, in-natura policy or ‘budget’ policy.
2. The healthcare provider may or may not have a contract with your healthcare insurance
Where there is contracted care, 100% of the costs is reimbursed by the health insurance company.
In the case of non-contracted care, the reimbursement depends on the policy you have chosen.
The exact reimbursement (%) is stated in the policy you have chosen and can be obtained from your health insurance company.

The bill
The healthcare provider does or does not have a contract with your health insurance company.
2.1. When there is a contract with the health insurance company, the costs will be reimbursed by the health insurer.
When there is a contract with the health insurance company, the declaration takes place via Vecozo.
There is a contract with: DSW, Stad Holland.
2.2. When there is not a contract with the health insurer
You will receive a bill each month.

You are responsible for the choice of the health insurance company and the insured package of your policy and therefore for the extent to which the healthcare is reimbursed by the health insurance company. If you have any questions about reimbursements, please contact your health insurer. We also like to think along with you.
Health care not reimbursed by the health care Insurance company
Additional care product ‘overig zorgproduct ‘(OZP) S-GGZ
Treatment of certain problems will not be reimbursed according to the healthcare insurance agreements and thus are not eligible for reimbursement.
Partner – relationship therapy will not be reimbursed. The exception to this is when an underlying psychological problem is the cause of relationship problems. In this case your general practitioner can write you a referral letter.
Relationship therapy sec, work problems and adjustment disorders will not be reimbursed.
Whenever you would like treatment for these particular problems, you would be obliged to take care of the expenses yourself. Then treatment interviews will be charged per session. In some cases you will be able to partially get your costs reimbursed when you have an additional insurance ‘aanvullende verzekering’. Always consult your insurance company about this issue.

Terms of payment
The terms of payment apply to all parts and arrangements.
You are responsible for the payments.

In case of foreclosure or change in appointment, you are required to give notice of this
24 hours prior to the appointment, either by phone (voice mail) or email. If you do not cancel an appointment 24 hours beforehand the associated costs will be charged.

2022 ZPM treatment rates.
Our practice also provides psychological treatment to people who are insured with a health insurer with whom we have not concluded a contract.

When our practice doesn’t have a contract, our practice applies 75% of the attached maximum rates for the health care psychologist (GZ-psycholoog) set by the NZA.

When our practice doesn’t have a contract, our practice applies 75% of the attached maximum rates for the psychotherapist set by the NZA.

When our practice doesn’t have a contract, our practice applies 75% of the attached maximum rates for the clinical (neuro) psychologist set by the NZA.

Consultation rates for self-payers (for psychological treatment) of the costs that are not reimbursed from the basic insurance:
The rate is 100% of the maximum rate set by the NZa € 117,33. This rate is per 60 minutes.

Conditions and rate no-show:
The rate for no-show is equal to the rate for the missed appointment.