Healthcare costs and insurance
There is a lot of uncertainty about the reimbursement of healthcare costs in specialist medical care. We would like to give you more clarity on this.
We can immediately provide certainty about one thing: at PoliDirect you only pay the deductible (eigen risico) and no personal contribution (eigen bijdrage). The costs for a visit to PoliDirect are therefore the same as for a hospital visit.
The care you receive from PoliDirect is covered by your basic insurance. This means that your insurer is obliged to reimburse the costs. You can subdivide the healthcare costs that are charged into the reimbursed part, the deductible (eigen risico) and a potential personal contribution (eigen bijdrage). Just like in the hospital, you are obliged to pay your deductible (if you still have an deductible outstanding). The health insurer may charge a personal contribution for the treatment (for example, if there is no contract with PoliDirect). You do not have to pay this personal contribution.
If you have a question or want a personal explanation, mail to firstname.lastname@example.org or call 088 888 45 55 (0ption 5).
How does it work?
The method of financial settlement depends on the care provided and whether or not there is a contract with your health insurer. Financial settlement starts at least 90 days after your visit to PoliDirect. In order not to immediately flood you with information, we will tell you exactly what to do if something is expected of you.
Depending on the care ultimately provided and whether or not a contract with your insurer exists, you will receive (a) an invoice from your health insurer for the deductible or (b) an invoice from PoliDirect. See the images below.
We can ask you at the counter to sign an ‘akte van cessie’. With this assignment you give PoliDirect permission to submit the invoice on your behalf to your health insurer. Please note: not every insurer allows this. If the insurer does not allow it, you will receive the invoice from PoliDirect yourself. In this case you can then declare the invoice with your health insurance yourself.
More information about healthcare costs and insurance
The healtcare you receive at PoliDirect is covered by the basic insurance. The basic insurance is a compulsory health insurance for everyone who lives and / or works in the Netherlands. The basic insurance covers the standard healthcare costs, such as a visit to the doctor, but also all kinds of examinations and treatments.
What is the deductible (eigen risico)?
Anyone who has Dutch health insurance and is 18 years or older has to deal with the deductible each year. The deductible is a threshold amount of money that you have to pay yourself and applies to most healthcare costs that are covered by the basic insurance.
In short: you pay the healthcare costs yourself up to the amount of the deductible.
The government determines the amount of the statutory deductible annually. Currently, the amount is € 385 in the Netherlands. You can increase this to a maximum of € 885 per year to reduce your monthly premium. Everything that is more than the deductible is reimbursed by the basic insurance.
If you undergo an examination and treatment of € 900, you will therefore only pay € 385. The other € 515 (including any personal contribution) will be reimbursed. Have you already drawn up your deductible? Then the full amount will be reimbursed. The deductible counter restarts every year.
Pay attention! The deductible (eigen risico) is different from the personal contribution (eigen bijdrage).
Wat is a personal contribution?
If there is no contract between your healthcare provider and health insurer, the health insurer may charge a personal contribution (in addition to the deductible).
We do not have a contract with all health insurers, but at PoliDirect you will not be faced with unexpected costs. You do not have to pay the personal contribution. This is waived by PoliDirect.
This way everyone gets the same care for the same price. That’s fair!
What is the akte van cessie for?
The akte van cessie is a kind of consent form. With the assignment (akte van cessie) you give PoliDirect permission to submit the invoice on your behalf to your health insurer. We can ask you to sign it at the counter. Note: not all health insurers allow this.
If the insurer does not allow it, you will receive the invoice from PoliDirect yourself. In this case you can then declare this yourself with your health insurance.
We will send you or your health insurer the invoice at least 90 days after your visit to PoliDirect.
Have you received an invoice and would you like more information about it?
How are healthcare costs determined?
If you have been referred to us, we will start a care process, also known as a DBC (diagnosis-treatment combination). All care activities that we perform to be able to diagnose or treat a condition are registered as “care products” in your care process. You can see the care process as a kind of digital folder, in which all activities are stored.
At least 90 days after your examination or treatment at PoliDirect, we will draw up an invoice containing all healthcare costs incurred based on the registered healthcare products in your healthcare process.
These costs depend on a number of factors:
- What type of care is necessary: this can vary from the prescription of medication to an examination, surgery or surgery.
- The number of visits to the specialist required.
This means that we can only indicate afterwards which total healthcare costs have been incurred.
De zorgkosten die u bij ons maakt, zijn afhankelijk van een aantal factoren o.a.:
- De soort behandeling waarvoor u verwezen bent;
- Welk soort behandeling noodzakelijk is: dit kan variëren van het voorschrijven van medicatie tot een onderzoek, ingreep of operatie;
- Het aantal bezoeken bij de specialist dat nodig is.