Reimbursement

Het Zorgprestatiemodel – The Care Performance Model starting in 2022

The new way all costs made in mental healthcare will be calculated and reimbursed starting in 2022

On January 1, 2022, something will change in mental health care. The Care Performance Model is 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, there is a much lower administrative burden for our therapists and we can also add new components to treatments that we see as very valuable, but were not previously reimbursed.

All current treatmentplans in our current system will be administratively closed on December 31, 2021 and new treatmentplans will be opened on January 1, 2022, according to the Care Performance Model.

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

1. Reimbursement specialist mental healthcare

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 60 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.

The level of rates is determined nationally by the Dutch Healthcare Authority (NZA – Nederlandse Zorg Autoriteit). We have no influence on this. What we do have influence over is what we charge.

 

Mental healthcare accessible for everyone at Focus GGZ

Because we want to keep mental healthcare accessible for everyone, we have set fixed minimum rates for our healthcare for all clients who are insured with health insurers with whom we do not have a contract.

If we do not have a contract with your health insurer and you do not have a refund policy either, your health insurer will reimburse between 65% and 80% of the NZA rate. Because we want to keep costs low and make care accessible to everyone, we as Focus GGZ have set fixed minimum rates that come down to approximately 79% of the national rates set by the Dutch Healthcare Authority.

If we do not have a contract with your health insurer, this is a major advantage for you. This means that you only have to pay a relatively small part of a consultation yourself!

If you are insured with an insurer with which we have a (payment) agreement, we will send the invoice directly to your health insurer and the full amount will be reimbursed in any case.

Example intake:

  • You have been on your first intake session with a psychologist at Focus GGZ
  • This intake takes appr. 90min
  • You will receive an invoice that week for € 295,00 based on the Focus GGZ rate (the NZA rate is € 366,46)
  • You are insured with a health insurer with which we do not have a contract. This health insurer reimburses 65% of the NZA rate
  • This means that the health insurer reimburses € 366,46 x 65% = € 238,20
  • In this case you have to pay € 56,80 yourself (€ 295,00 (invoice) – € 238,20 (reimbursed by health insurer) = € 56,80)

Example treatment:

  • You have received treatment at Focus GGZ
  • You have a weekly session with a psychologist of appr. 60min
  • You will receive an invoice every week for € 161,00 based on the Focus GGZ rate (the NZA rate is € 201,29)
  • You are insured with a health insurer with which we do not have a contract. This health insurer reimburses 65% of the NZA rate
  • This means that the health insurer reimburses € 201,29 x 65% = € 130,84
  • In this case you have to pay € 30,16 yourself (€ 161 (invoice) – € 130,84 (reimbursed by health insurer) = € 30,16)

3. NZA & Focus GGZ rates 2022

Below you will find an overview of the most common consultations (number of minutes per consultation), per professional group, with the rate as determined by the Dutch Healthcare Authority (NZA) and the minimum rate determined by Focus GGZ.

Diagnostic consultation psychologist

MinutesNZA rateFocus rate
5€ 59,97€ 47,00
15€ 99,99€ 79,00
75€ 296,88€ 237,00
90€ 366,46€ 295,00
120€ 507,01€ 405,00

 

Diagnostic consultation GZ-psychologist

MinutesNZA rateFocus rate
5€ 64,36€ 51,00
15€ 107,89€ 86,00
60€ 271,78€ 217,00
120€ 557,33€ 445,00

 

Diagnostic consultation clinical psychologist

MinutesNZA rateFocus rate
5€ 78,22€ 62,00
15€ 131,97€ 105,00
45€ 318,43€ 254,00
120€ 697,38€ 557,00

 

Diagnostic consultation psychiatrist

MinutesNZA rateFocus rate
5€ 111,61€ 89,00
15€ 182,14€ 145,00
45€ 389,04€ 311,00
60€ 422,01€ 337,00

Treatment consultation psychologist

MinutesNZA rateFocus rate
5€ 43,73€ 35,00
15€ 75,28€ 60,00
45€ 179,30€ 143,00
60€ 201,29€ 161,00
90€ 299,89€ 239,00

 

Treatment consultation GZ-psychologist

MinutesNZA rateFocus rate
5€ 47,21€ 40,00
15€ 81,69€ 65,00
45€ 196,85€ 157,00
60€ 221,47€ 177,00
90€ 330,20€ 264,00

 

Treatment consultation clinical psychologist

MinutesNZA rateFocus rate
5€ 57,38€ 45,00
15€ 99,82€ 79,00
45€ 246,97€ 197,00
60€ 275,97€ 220,00

 

Treatment consultation psychiatrist

MinutesNZA rateFocus rate
15€ 135,96€ 108,00
30€ 220,54€ 176,00
45€ 304,99€ 243,00
60€ 344,41€ 275,00

4. Reimbursement and payment of care at Focus GGZ

Are you insured with one of the insurers with which we have a (payment) agreement?

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

It may be that we do not have an agreement with your health insurer, but we do have the agreement that we may declare directly, on your behalf, to the health insurer. In that case, they generally do not reimburse the Focus GGZ rate that we have charged. We will then send you an invoice for the part that they have not reimbursed. The amount depends on your policy. You can then make the calculation as made in the examples above.

Are you not insured with one of the insurers with which we have a (payment) agreement?

You will receive an invoice by email after each consultation. You can easily pay this invoice with an iDeal link that is in the email. You then upload the invoice, which is attached to the email containing the iDeal link, to your health insurer. The health insurer will then reimburse the majority or all of the invoice to you. This depends on how you are insured.

Overview of all health insurers:

Health insurers with whom we have a contract and where we can send the invoice directly to the insurance company:

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

Health insurers with whom we do not have a contract, but where we can send the invoice directly to the health insurer:

  • VGZ (UMC, IZA, Univé, Zekur, Bewust, IZZ, Promovendum, National Acadamics, Besured)
  • ONVZ (PNOzorg, VvAA, jaaah.)

Health insurers with whom we do not have a contract, where we cannot send the invoice directly to the health insurer, which means you will receive the invoice:

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

5. No show rate

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

With the introduction of the Care Performance Model, we can only charge for direct contact with our clients. This includes: the sessions at our location, conversations via Zoom or by telephone, or treatment-related e-mails.

Previously, we could charge not only direct time, but also indirect time; so consultation moments between therapists, administration, all reports that have to written, letters to the GP, etc. If a session fell out, we could partly compensate by filling that hour with administrative matters for other clients. That is why we were able to charge a lower no show rate.

All this indirect time can no longer be included in the declaration from 1 January 2022, which is why we are forced to apply a different no show rate and a different term for cancellations.

No-show policy starting on January 1st, 2022

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 is not canceled at all, we will charge a no show rate.

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

For other appointments on location, via Zoom or by telephone, a no show rate will be charged in the amount of 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. For the rate you can look in the aforementioned list. Then select the correct professional group, the planned duration of the consultation and whether it concerns a diagnostic or treatment consultation.

Example

  • If you have a regular treatment consultation of 60 minutes with your therapist, the amount of your no show rate is € 161
  • If you have an evaluation consultation of 45 minutes with your therapist and the supervising therapist who is a GZ-psychologist (a mandatory part of the treatment), the amount of your stay-away rate is € 143 (therapist) + € 157 (supervising therapist) = € 300

If you are in treatment with us, it is of course possible that you cannot cancel the appointment in time. That’s why we meet you half way when canceling late 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 an appointment twice, we will discuss whether this is the right time for you to follow therapy. Failure to consistently attend treatment stands in the way of successful treatment. As a result, we cannot 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.