Reimbursement

Reimbursement from health insurance

ADHDcentraal’s specialist medical care is reimbursed from your Dutch health insurance’s basic package.
ADHDcentraal does its best every year to reach agreements with all health insurance companies regarding reimbursement for our diagnostics and treatments. For 2024, we have contracts with most insurers.
If there is an agreement, the cost of diagnostics and treatment will be reimbursed from your health insurance. Of course, a mandatory deductible does apply.
The health insurance company will reimburse only after a valid referral from the general practitioner for Specialist Mental Health Care (GGZ) or a referral from your directional mental health practitioner.

The overview below shows which insurers we have an agreement with:

* DSW says it cannot guarantee that ADHDcentral’s care will be reimbursed through 2024. Unfortunately, to avoid unnecessary costs for patients, we are forced to implement a patient stop for DSW insured (DSW, StadHolland, InTwente).

Reimbursement for non-contracted care

If we do not have a contract with your Dutch health insurer, we will cover part of the unreimbursed costs. With this grace period, we keep our care widely accessible.
In the case of this non-contracted care, it matters which policy you have. With a restitution policy, the health insurance company reimburses 100%, but with a natura policy, it reimburses less. Thus, for the portion of unreimbursed costs, the goodwill rule applies.

You pay part of the cost yourself in the case of non-contracted care: the personal contribution. If you come to us for treatment after the diagnosis day, the personal contribution is €250. If you are referred back to your GP by us after the diagnosis day, for example because the diagnosis of ADHD cannot be made, a personal contribution of €100 applies.

An example:
You are insured with a health insurance that ADHDcentraal does not have a contract with.
With this insurance, you still have €300 deductible outstanding at the time you enter treatment.
You are diagnosed with ADHD and enter treatment. You will then pay the personal contribution of €250. You will not be prescribed medication that is subject to a co-payment.
You then pay in total, the deductible to your health insurance company plus the co-payment to ADHDcentraal, € 300.- + € 250.- = € 550.

The date of the diagnostic day will determine if a personal contribution is applicable in your case. The personal fee is charged in one lump sum after the diagnostic day.
More information about paying the personal contribution can be found at Payment of contribution.

For patients with foreign insurance, it always applies that the patient must pay the entire cost of diagnostics and/or treatment himself to ADHDcentraal. The patient will have to arrange any reimbursements themselves with the foreign health insurer.

If you are insured with one of the labels that ADHDcentraal has a contract with, you do not pay a personal contribution. You do pay your outstanding deductible if applicable.

Own risk

Everyone has a legally required deductible per year with their health insurance. If your deductible has not yet been used in the year in which the claim is submitted to the insurer, your deductible will be withheld. The date of your first appointment with the practitioner determines your deductible. The deductible also applies to other health care providers within the mental health system.
In all cases, the statutory deductible is used in full when you attend the diagnostic day and/or treatment with us.

Own contribution medication

Medication has an important place in the treatment of ADHD. This medication will be prescribed by us and provided by your pharmacist. Depending on the drug prescribed, there may be a co-payment from the health insurance law. The law states that this can be a maximum of €250. This co-payment will be charged to you by your insurer. This goes beyond ADHDcentric.

You may have supplemental insurance for these costs. Check with your insurer for this. Some manufacturers have a refund policy for this co-payment. For that, see the following links:

Repayment scheme Tentin




Repayment scheme Elvanse

Payment of personal contribution

In the case of uncontracted care, ADHDcentraal will charge you or your health insurance company for the cost of treatment on a monthly basis. This depends on the agreements we have with your health insurance company, with which we ourselves have not entered into a contract.

If there is no contract with your health insurer, but there is a payment arrangement with your health insurer, ADHDcentraal can handle the billing directly through your health insurer. In these cases, a co-payment (the personal contribution as mentioned above) does apply for diagnostics and treatment. ADHDcentraal will invoice you directly for the personal contribution.

If there is no contract with your health insurance company and no payment arrangement, you will receive invoices directly from ADHDcentraal. This is done monthly through Infomedics, after which you have to submit / declare it to your health insurer yourself. From your health insurance company, you will then receive a note or claim statement. You send these to ADHDcentral. ADHDcentraal calculates the actual amount you have to pay Infomedics on this basis. Look here for more information about Infomedics.

Specifically, we have a payment arrangement and no contract with ONVZ. There we do bill directly to health insurance companies, but the patient does receive an invoice for the personal contribution afterwards (if natura policy).

Deductibility of medical expenses

Healthcare expenses may be deducted in the tax return under certain conditions. More information can be found here.

Reference

A referral from your primary care physician or directional mental health practitioner to Specialist mental health care is required.

About the rates

The rates for the care provided by ADHDcentraal are in accordance with the tariff decision as drawn up by the Dutch Healthcare Authority (NZa).