Fee

Version: 21-04-2022


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:

Rates:
– 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.

Please note!
– 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 reimburses 100% of the final invoice to you.
Combination policy, this sometimes reimburses 100% to you, but sometimes also less.
Natura policy, which reimburses a lower amount, often between 60-80%.
Budget policy, this reimburses less than 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 do not need to take out additional insurance.
You are welcome with any policy, keep in mind that you have to pay a part if you do not have a refund policy.

* Read more about the refund policy here:

 

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 it concerns sessions of 60 or 90 minutes within the SGGZ care that in the latter case will exceed the 3000 minutes limit, reimbursement for this was once agreed with the health insurers through negotiations but there are health insurers that have still completely rejected reimbursements for this reason.
– Indicate if you are still being treated elsewhere, this is not always allowed at the same time.
– Check which diagnostic codes may not be reimbursed (for example if you are still in treatment elsewhere)
– Check how much your annual deductible is, standard this is 385,-.
– State that you will not submit a treatment plan, ROM measurements, or diagnosis codes to your health insurer (but a privacy statement). N.b. some insurance policies do not accept 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), with sessions of 90 minutes.