Health insurance costs
Check your health insurance (and arrange a correct referral letter in time: usually something still needs to be corrected and GPs do not antedate referral letters) before the telephone screening, so that you know in advance what percentage you will be reimbursed monthly for the uncontracted care with me, within the Specialist Mental Health Care (SGGZ).
Rates (insured persons and self-payers)
You can also choose to pay for the treatment yourself, this is without the intervention of your health insurer.
I use the same so-called 'high rate', for psychiatrists, of the Care Performance Model (ZPM) for both self-payers and clients whose care goes through their health insurance. These rates are set annually by the Dutch Healthcare Authority (NZa) and include all administrative time:
– Treatment session : € 236,41 per hour
– Diagnostic sessions : € 268,31 per hour.
* N.b. These rates therefore include indirect time (all administrative time). In practice, this administrative time (unfortunately) often all together covers an almost comparable part as the direct treatment time (face to face talk time), and consists of: elaboration of diagnostic and intake interviews, reports, gp letters, (sometimes) additional referrals, (sometimes) laboratory research, e-mails, workflow, making treatment plans, a treatment agreement, etc.
* Diagnostic sessions take place at the beginning of a new treatment (telephone screening (45 min), trial treatment (60 min), and the intake procedure of 2 to 4 times 60 min.
Coaching, companies or self-employed expenses
Sometimes the cost of self-payers in the tax can be increased as operating costs such as : coaching, disease costs or training costs.
This can take place, for example, in the context of a reintegration process, or within a plan for personal development.
* However, pay attention to the conditions of the tax, such as the so-called 'threshold-free foot'.
CHECKLIST health insurance
What percentage of the invoices you can get back from your health insurer depends on your type of policy and the policy conditions. When placed on the waiting list, I will send you additional information on how to find out what percentage you will be reimbursed.
– The final invoice will be addressed to you. If you are only partially reimbursed by your health insurance, you will have to pay the rest yourself. You must also pay the final invoice yourself if your health insurance would reject you the final invoice and does not pay you in its entirety.
– You are responsible for checking your health insurance and policy conditions, as well as possibly obtaining permission for reimbursement of therapy from me in advance by your health insurance.
* You must check the policy conditions yourself annually whether something has changed with regard to the reimbursement and / or conditions.
Step 1. Check which policy you have
– Refund policy, this may reimburse 100% of the final invoice to you.
– Combination policy, this may reimburse 65-90% sometimes 100% to you, but sometimes also less.
– Natura policy, this reimburses a lower amount, possibly around 60-80%.
– Budget policy, this may reimburse less day / around 50-75%.
Switching and / or changing from policy (to a refund policy) can usually be arranged from mid-November to the beginning / end of January yourself .
You are welcome with me with any policy, remember that in some cases you have to pay a part if you do not receive full reimbursement, you remain responsible for checking the (possibly new) conditions of your health insurance policy in a timely / annual manner.
* Read more about the refund policy here:
- More information about the refund policy
- Conditions and pitfalls refund policy
- Overview of refund policies and rates
- Explanation of the difference between a refund policy, in-kind policy and basic policy
Step 2. Check the coverage conditions (ask permission 'black and white' by email)
– What percentage your policy will actually reimburse for this treatment, and whether this is a percentage of the full rate (the legally established rate, also known as the WMG/NZA rate ).
– Or that it actually turns out to be the same percentage but of a lower amount / rate that your health insurer has set itself (the latter rate often misleadingly call care providers the so-called 'market-based rate' or the 'average contracted rate'. This naming is misleading because the fee for this is sometimes lower, and therefore not always completely/market-based, so that the client has to pay a part of it himself). This is particularly common with the combination policy, which is why this policy is also called an 'impure restition policy' (not a real refund policy).
– If it nevertheless turns out to be reimbursement of a 'market-based rate', how much this will possibly be lower than the statutory WMG/NZA rate for this treatment (i.e. the amount on your final invoice). This means that you have to pay that part yourself afterwards.
– Indicate that these are sessions of 60 (sometimes 90) minutes within the SGGZ care, and check whether there are (additional) conditions (such as an indication in advance).
– Indicate if you are still being treated elsewhere, treatments may not always take place at the same time or overlap.
– Check which diagnosis codes may not be reimbursed (for example if you are still in treatment elsewhere)
– Check how much your annual deductible is, standard this is around 385,-.
– Mention that you will not submit diagnostic codes to your health insurer if requested (but a privacy statement).
Step 3. Check the referral letter
It is necessary for reimbursement that before the start of your treatment, you will receive a referral letter from your general practitioner stating that it concerns 'non-contracted care within the Specialist Mental Health Care' (SGGZ), addressed to T.Laduc, psychiatrist, on suspicion of a DSM-5 diagnosis.