Het Zorgprestatiemodel – The Care Output 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 Output 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 Output Model will mean for you as a client? Read more here…

Below you can read everything about how the reimbursement works until December 31, 2021

Reimbursement for 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.

Costs

The costs of your treatment are determined by the number of minutes spent on your file. This applies to direct minutes (minutes spent on face to face and telephone contact, but also contact via video calling) and indirect minutes (minutes spent on reporting, consultation and contact with, for example, your general practitioner). Rates are linked to the number of minutes. These rates are determined nationally by the Dutch Healthcare Authority. We have no influence on this. Click here for the document in which all fixed rates for 2021 are stated.

Your financial contribution

This applies to all treatments that start before November 1, 2021

Mental health care is always (partly) reimbursed by your health insurance and is included in the basic package, so you will be reimbursed for most of your treatment in any case. The amount of the reimbursement can differ per health insurance. Some health insurerances reimburse 100% of the rate set by the Dutch Healthcare Authority, and others, for example, only 60%. If we do not have a contract with your health insurer and you do not have a full refund policy (i.e. the insurer pays out up to 100% of the NZA rate), your treatment will only be partially reimbursed. In that case, Focus GGZ will bear part of these non-reimbursed costs. However we do request that you  make a one time contribution towards the costs of € 250. This only applies if you actually start treatment after the intake. You will receive the invoice by e-mail after the intake, at the start of the treatment. The contribution to the costs is separate from the Health Insurance deductible (Eigen risico).

Claiming the costs for your treatment

You will always receive an invoice for the healthcare you received when your file is closed. This can be after the intake, if it turns out that we do not have a suitable treatment for you, if you want care elsewhere, or if the treatment has been completed.

Contract with your health insurer:

When we have a contract with your health insurer, you do not have to do anything: we will send the invoice directly to your health insurer. You will receive a payment specification after completion. In some cases, even though we do not have a contract, we may still declare directly to the health insurer.  Also in that case, you don’t have to do anything.

No contract with your health insurer and we cannot send the invoice to the health insurer:

You will receive our invoice for your treatment by email. You then submit this to your health insurer yourself. They will let you know which amount they reimburse you. This will be the amount that you transfer to us. As soon as you have transferred that amount to us, and sent us the payment specification by email, you will receive a credit invoice for the difference. To do this, follow the next steps.

Payment of invoice:

• As soon as you have received reimbursement from your health insurer, you use this amount to pay our bill
• To show us that the amount you paid us corresponds to what you received from the health insurer, please send us the payment specification from your health insurer to: vergoeding@focusggz.nl
• After we have received and verified it, you will receive a credit note (remission) from us for the remaining amount

Health insurance deductible

The amount of the statutory health insurance deductible, which the insured has agreed with the health insurer, is always at his own expense. Even if you refrain from further treatment after the intake. The health insurer can specify these costs as part of your statutory deductible. Your intake and treatment will be settled by your health insurer against your outstanding deductible.

The statutory deductible on the health insurance is determined by the government every year. This is the mandatory minimum amount charged by your health insurer for all care used in a calendar year. For 2021 that amount is € 385.

You must therefore always pay your deductible if you receive care in the Netherlands and it is completely separate from the care we provide. So whether you go for treatment with us or somewhere else or receive another form of care, you will always be held responsible for this amount.

This means the following:

• If your health insurer has transferred amount X, but you still have to pay € 385 euro excess yourself. Then you have to transfer the amount X + € 385, – to us.
• Only transferring amount X to us is then not sufficient.
• We can only send the credit invoice when the amount paid out by your health insurer + the deductible has been transferred to us.

Overview of all Dutch Health insurers:

Health insurers with whom we have a contract and for which the one time contribution does not apply are:

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

Health insurers with whom we do not have a contract, for which the one time contribution does apply, but where we can send the invoice directly to the health insurer:

• VGZ (UMC, IZA, Univé, Zekur, Bewust, IZZ, Promovendum, National Acadamics, Besured)

Health insurers with whom we do not have a contract, for which the one time contribution does apply and 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)