Reimbursement

Het Zorgprestatiemodel – The Care Performance Model

On January 1, 2022 The Care Performance Model has been introduced. This is a new way in which mental health care in the Netherlands is calculated and reimbursed. Focus GGZ sees this as a good development. It is much more transparent for clients and we can also add new components to treatments that we see as very valuable but were not previously reimbursed.

Would you like to know what the introduction of the Care Performance Model will mean for you as a client? Read more here…

1. Specialist mental healthcare at Focus GGZ

Focus GGZ offers specialist mental health care. This is in comparison with medical care: if you have a serious knee injury, you will be referred  to a specialist in that field, an orthopedist by, for example, your general practitioner. The same applies to mental health care. If you have psychological complaints that have reached a certain level, you will be referred to a specialist in mental health care. This means that you will need a referral letter from your general practitioner in order to receive  reimbursement by your health insurance for our treatments. We must receive this before the intake. If you do not have a referral letter, the intake cannot take place.

Do you have milder complaints and desire to talk to a professional, or not wish to see your general practitioner first? Then we also offer the option to pay for the treatment yourself. Read more about that at the bottom of this page.

2. Calculating the costs of care at Focus GGZ

With the arrival of the Care Performance Model, the funding of mental health care becomes clear and transparent. The costs of your treatment are determined by the duration of your consultation, the profession of the professional with whom you have that consultation and whether it is a diagnostic or treatment consultation. In addition, your therapist may find it necessary for your treatment to consult with an external colleague. Then we charge inter-colleague consultation.

The rates also include all time spent on administration and consultation outside the sessions. If you have a treatment consultation of 45 minutes, then an average of 10 to 15 minutes extra time will be added for, among other things, consultation and reporting. The difference between a diagnostic consultation and a treatment consultation lies in the additional consultation between the performing therapist and the supervising therapist and the administrative actions associated with an intake. During a diagnostic consultation, more extensive reports must be written, tests must be elaborated, letters to the general practitioner must be written and there must be consultation within the team at several moments. In order to cover the costs of all these extra actions, the rate for a diagnostic consultation is higher than that for a treatment consultation.

3. Reimbursement and payment of care at Focus GGZ

The maximum rates for mental healthcare in the Netherlands are determined by the Dutch Healthcare Authority (NZa). Focus GGZ uses the nationally determined rate. If we have a contract with your health insurer or if you have a restitution policy, your treatment will be fully reimbursed.

If we do not have a contract with your health insurer and you do not have a restitution policy, your treatment will be largely reimbursed. This means that you have to pay a personal contribution. This is the difference between the reimbursement by your health insurer and the invoice amount. In order to meet these clients’ own contribution, we offer a compensation of 19% of the total invoice amount.

4. The billing process

 

Are you insured with one of the insurers with which we have a contract?

Then you don’t have to do anything. We will send the invoice directly to your health insurer and they will reimburse the full amount to us.

This is the case for:

  • S.R. (De Amersfoortse, Ditzo)
  • DSW (City of Holland, In Twente)
  • Eucare (Aevitae)

 

Are you not insured with one of the insurers with which we have a contract?

Then you will receive an invoice by email on the first of every month for the sessions you have had in the previous month. You submit this invoice to your health insurer; they will pay you the reimbursed amount.

You can easily transfer the amount you owe us by using the iDeal link in the email.

This is the case for:

  • Menzis (Anderzorg, Hema)
  • CZ (National Netherlands, Ohra, Just, CZ direct)
  • Achmea (De Friesland, FBTO, Interpolis, Zilveren Kruis, ZieZo, ProLife, AON
  • Eno (Salland, ZorgDirect)

 

Please note – this applies to all labels from VGZ and ONVZ

It may be the case that we do not have a contract with your health insurer, but we do have an agreement that we may send in the invoice directly to the health insurer on your behalf. This is the case with all labels from VGZ and ONVZ.

If you are insured with them and you do not have a refund policy, you will also receive the compensation of 19% on the total invoice amount. What the insurer pays us is usually less than that, so you will receive a separate invoice from us for the difference. This is your own contribution.

This is true for:

  • VGZ (UMC, IZA, Univé, Zekur, Bewust, IZZ, PhD candidate, National Academics, Besured)
  • ONVZ (PNOzorg, VvAA, yes.)

5. Deductible excess (Eigen risico)

Mental healthcare falls under the deductible excess. If you have not yet used your deductible excess in full, your health insurer will deduct this from the reimbursement. The deductible excess, possibly increased voluntarily, is always at your own expense. Even if you renounce further treatment after intake.

Your intake and treatment will be settled by your health insurer against your outstanding deductible excess. The health insurer will specify this deduction on the statement overview under the deductible excess. The deductible excess on health insurance is determined each year by the government. This is the mandatory minimum amount that is charged by your health insurer for all care used in a calendar year, for 2022 that is  € 385,-. If you have voluntarily increased the compulsory deductible, the deductible is a maximum of € 885,-.

You always have to pay your deductible excess annually if you receive care in the Netherlands and it is completely separate from the care we provide. So whether you go on an intake or treatment with us or elsewhere, you will always pay this amount.

Overview of all health insurers:

Overview of maximum reimbursement per insurer:

6. No show rate

PLEASE NOTE: Cancel your appointment in time if you are unable to attend!

No show rate intake session

We charge €250 for an intake. If you still want to make use of the care provided by Focus GGZ and therefor want to schedule a new intake session, this is only possible in consultation with the intake coordinator and after paying the no show rate.

No show rate for a treatment consultation (on location, via Zoom or by telephone)

In the unlikely event that an appointment cannot take place, we ask you to cancel the appointment at least 48 hours (2 working days) in advance, or on Thursday before 12:00 if it concerns an appointment on Monday. This is free of charge.

If an appointment is canceled within 48 hours prior to the appointment, or after 12 noon on Thursday if it concerns an appointment on Monday, or not canceled at all, we will charge a no show fee. This is equal to the value of the relevant appointment. We can then no longer schedule a new client and therefore no longer fill that time with other billable activities. You can check our website for the rate.

If you are undergoing treatment with us, it can of course happen that you are unable to cancel a appointment in time. That is why we meet you at the first time by charging half of the no show rate. After this first leniency, we will charge the full rate.

If you have not come to a treatment appointment twice, we will discuss whether this is the right time for you to follow therapy. Failure to consistently attend treatment appointments hinders successful treatment. We can therefore not guarantee the correct care. There is then a chance that we will terminate the treatment.

6. Pay yourself

Sometimes you can get stuck in certain areas of your life and you need to talk about this with a professional. However, if your symptoms are too mild to make a diagnosis of a DSM disorder, this psychological help will not be reimbursed by the health insurer. In that case you can contact us for treatment that suits your request for help. The costs of the sessions are then for your own account.

The rate depends on the request for help and the profession of the therapist who best suits it. Call or email us to get an indication.

(Care is exempt from BTW)

Even if you have more serious complaints, but do not want your health insurer or GP to be informed about your treatment, you can opt for treatment that you pay for yourself.