Reimbursement of the costs

Costs
Your general practitioner is very important here and discusses with you what help is needed. After a referral by your general practitioner/POH GGZ, to my private practice, treatment will be offered from either ‘generalistische basis’ GGZ or ‘specialistische’ GGZ.

Generalistische basis ggz
People with mild, non-complex, psychological problems can be treated within the ‘generalistische basis’ ggz. From 2014 and onward, several types of treatments (or products) are offered that are reimbursed by the basic insurance ‘basisverzekering’. These are the basic short (300 minutes), basic average (500 minutes), basic intense (750 minutes) and basic chronic (750 minutes) modules.
A referral letter from your general practitioner is needed.
For the rate decision of 2019 of the ‘generalistische basis GGZ’ you can use the following link:
https://puc.overheid.nl/nza/doc/PUC_243894_22/1/ 

Specialistische GGZ (S-GGZ) (specialistic mental health care
Special mental health care GGZ is intended for people with severe psychological problems or instable problems.
Again, you will need a reference from your practitioner if you are to receive special mental care. In this type of care, there will be worked with so called DBC’s. A DBC is a diagnostic treatment combination. It has a duration of a year maximum. After this, if needed, a follow-up DBC can be opened for an extended treatment. The treatment is reimbursed from the basic insurance. The Dutch health care authorities (NZa) determines the DBC rates. After the treatment has ended, this rate is established based on the diagnosis for treatment and based on the total amount of time (minutes) spent on treatment by the therapist (direct and indirect time e.g.  report, letter, telephone calls, email correspondence).
For the rate decision of 2019 of the ‘specialistisches GGZ’ you can use the following link:
https://puc.overheid.nl/nza/doc/PUC_243890_22/1/

For general information  you can use the website of the NZa www.nza.nl

Eigen bijdrage
For the basic insurance, every adult has a compulsory deductible. For 2019 the ‘eigen bijdrage’ is € 385. This means that you have to pay the first € 385 of your healthcare costs yourself. Only then will your health insurer pay the costs.
The ‘eigen bijdrage’  is that certain amount of money that no health Insurance company will  reimburse.  That part will be charged to you by Psychotherapiepraktijk Drs. A. Notermans.

DBC: diagnosis-treatment-combination
In the beginning of treatment, a DBC will be opened. A health care provider is obliged to register all diagnostic and treatment related activities in this DBC. After treatment has ended and after the DBC has been open for one year, it will be closed. Then we can calculate what the costs were up until that point, based on the total amount of time spent. The data originating from the DBC are anonymised and sent to the DBC information system (DIS) regarding policy objectives. Also, a bill will be sent by my administration office (VCD Healthcare) to your health care insurance company, when I have a contract with them. Your maximum costs will be equal to your ‘eigen bijdrage’ . When I do not have a contract with your health insurance company company, you can authorize me to receive the amount of the bill of the treatment directly from the health Insurance company. You do not need to pay the bill in advance.

Reimbursement basic Insurance
The percentage of reimbursement of your treatment depends on the following:
1. The insurance policy that you have chosen
This can be a ‘restitutiepolis, naturapolis or ‘budget polis’.
The exact reimbursement can be found in the policy you have chosen and can be checked with your health insurance company.
With a ‘restitutiepolis, Vrije keuze polis, Eigen keuze polis’ policy, your treatment is reimbursed for approximately 85-100%.
With a ‘naturapolis’ policy, the compensation can be about 65-68% of the costs.
With a ‘budget’ policy, the compensation can for example amount to 57 to approximately 62%.
You can also contact your health insurance company.

2.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.
My billing company  and the health insurance company directly handle this.
There is a contract with: DSW that offers all its clients a ‘restitution polis’ and its labels:  InTwente, Stad Holland, ASR; De Amersfoortse, Ditzo. Aevitae, Nedasco.
2.2. When there is not a contract with the health insurer, the reimbursement depends on the policy you have chosen and the  way in which the health insurance company wants to arrange the payment.
Several forms of charging the costs are possible. This depends on your health insurance company.
Which method applies to you is stated below:

Akte van cessie:
In 2019 most  health insurance companies don’t accept the ‘akte van cessie’ anymore. DSW and its labels and VGZ and its labels do accept the ‘akte van cessie’.
Psychotherapiepraktijk Drs. A. Notermans, after authorization, directly claims the costs with the health insurance company.  Before starting treatment you will be asked to sign the ‘akte van cessie’.
If you have signed for an act of assignment, whereby the invoice is sent directly to your health insurer, that part of the invoice that is not covered by your policy will be charged to you.
For this method of , there is also the possibility that you will receive an invoice after declaration for ‘de eigen bijdrage’ the personal contribution described above. In addition, ‘de eigen bijdrage’ the settlement of the deductible is also shifted. For this you will not receive an invoice from your health insurer, but from our practice.
The ‘akte van cessie’is accepted by VGZ and its labels: Bewuzt, De Goudse, IZA, IZZ, UMC, Univé, VGZ, Zekur,
VGZ volmachten/collectieven:  Aevitae, Nedasco United Consumers

The bill :
When you have chosen a health Insurance company that will not accept the ‘akte van cessie’ you will receive a bill each month.
After completion of the treatment and after a treatment (DBC) period of a year, the invoice will be sent over this period of time. In doing so, the amount that has already been paid will be deducted.
At the end of the treatment process, you will receive an invoice from us at 100% of the statutory NZA rate. The bill will be sent to you. You are responsible for the payment of this bill. You can submit this invoice to your health insurance company for reimbursement.
If the declaration of your treatment is not fully reimbursed by your health insurance company  and your treatment can start in the first year of treatment, then you are entitled to a reduction of your invoice to an amount of 85% of the ‘marktconforme/gemiddeld gecontracteerde tarief’ (market rate) set by your health care provider.
If your health insurance company pays less than 85% of this ‘marktconforme/gemiddeld gecontracteerde tarief’ (market rate), the difference will result in a personal contribution to be paid by you.

Responsibility:
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.

Cheap polices
These are cheap policies where the client has made the choice for a limited reimbursement of the care provided by the basic Insurance company.
When you have such a health Insurance policy: for instance a ‘beperkte naturapolis/zorgbewustpolis/directpolis (budgetpolis)’ the health Insurance company reimburses for instance 62% or less of the legal rate (NZa). Then you cannot come to my practice and just sign up for a treatment. Then you can contact your health care provider.

For this I bring the following to your attention:
In addition to the policy conditions, the insurance company must also comply with legal rules. These are in the Health Insurance Act (Zvw).
The obstacle criterion (hinderpaalcriterium) is part of this law. This ensures that the reimbursement that health insurers give, cannot be so low that insured people are prevented from opting for a specific healthcare provider. In this way, the obstacle criterion serves at the same time as protection for healthcare providers who cannot conclude a contract with Dutch health insurers. This applies, for example, to hospitals abroad.

When is there an obstacle?
Unfortunately, there are no mathematical criteria for this. That is why in practice it usually applies that there is an obstacle if the reimbursement for non-contracted care is less than
75 percent of the ‘marktconforme tarief’.
http://www.zorgvoorkwaliteit.nu/content/krijgt-de-cliënt-te-weinig-vergoed
Due to the judgement of the Judge, the difference in compensation between contracted and non-contracted care may only amount of 500 euros.
The obstacle criterion comes into effect for everything above it.

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.

Prices additional care product ‘Overig zorgproduct’ (OZP)
The maximum OZP-price for the ‘ozp non basic package consult’ is determined by the NZa and consists of the following price in 2019: € 105,25 per session ( 45 minutes direct time and 15 minutes indirect time). There is no BTW involved. You do not need a referral from your general practitioner.

Terms of payment
The terms of payment apply to all parts and arrangements.
You are responsible for the payments.
www.zorgwijzer.nl/vergoeding/psychologie

Cancelling
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.