Reimbursement

Reimbursement from the health insurance

The specialist medical care provided by ADHDcentraal is covered by the basic health insurance package. The amount of the reimbursement depends on the health insurer with which you are insured and the type of policy you have.

  • If you are insured with an insurer with whom we have a contract, diagnosis and treatment will be reimbursed in full, regardless of the type of policy you have.
  • If you have a reimbursement policy with your health insurer, diagnosis and treatment will be reimbursed 100%* Please note: a number of health insurers have changed their reimbursement policy into a ‘combination policy’ in which mental healthcare is no longer fully reimbursed. ADHDcentraal is therefore forced to charge a personal contribution to these insurers. In case of doubt, please contact your health insurance company to find out if they will reimburse 100% of the NZa rate for GGZ treatments.
  • If you have a package deal, combination deal or budget policy, diagnosis and treatment will be partly reimbursed. In these cases, our indemnity provision* applies. You can find information about your policy type in your policy conditions.

*You must pay your outstanding policy excess if applicable. This applies to all care providers within the Specialist Mental Health Care. Read more about this under the heading ‘Own Risk’.

 

Contract health insurance 2023

ADHDcentraal is currently in discussion with several health insurers about contracting our care in 2023. As soon as a contract has been concluded with an insurer, this will be published on this page of our website.

 

With which health insurer does ADHDcentraal have a contract in 2022?

For 2022, ADHDcentraal has a contract with ASR, Zilveren Kruis an CZ in the field of Specialist Medical Care. ASR offers insurance under the following labels in 2022:

  • a.s.r.
  • Ditzo

CZ will offer insurance policies under the following labels in 2022:

  • CZ
  • PZP
  • OHRA
  • Nationale Nederlanden
  • Just

Zilveren Kruis will offer insurance policies under the following labels in 2022:

  • Zilveren Kruis
  • Achmea
  • One Underwriting B.V.
  • FBTO Interpolis
  • De Friesland
  • Pro Life

If you are insured with one of the above labels, you do not pay a personal contribution. You can find information about your policy in your policy conditions overview. *You do pay your outstanding deductible if this applies. This applies to all care providers within the Specialist Mental Health Services. Read more about this under the heading ‘Risks’.

 

Coulanceregeling zorgkosten

We want to keep our care accessible to a wide audience. That is why, in the event that your healthcare insurer does not reimburse all healthcare costs, we will bear a large part of the non-reimbursed costs. You also pay a portion of the costs yourself: the personal contribution. If you come to us for treatment after the diagnostic day, the personal contribution is EUR 250. If we refer you back to your GP after the diagnostic day, for example because the diagnosis of ADHD cannot be made, a reduced personal contribution of EUR 100 applies. In practice, therefore, your costs for treatment at ADHDcentraal will never exceed EUR 250 (plus any outstanding deductible, see below under the heading ‘deductible’).

Deductible

Everyone has a statutory deductible per year with their health insurance. If, at the time of reimbursement, there is an amount outstanding as excess with your insurer, part of the reimbursement will not be paid to you but retained as excess. The deductible also applies to other care providers within the GGZ.

  • Up to and including 2021 the start date of your treatment was decisive for the deductible excess. A treatment started in 2021 therefore has consequences for your deductible in 2021.
    • Please note: Because of the change in the funding system within the general GGZ in 2022, all current treatments will be concluded at the end of 2021. This means that for a treatment started in 2021, your deductible will also be used in 2022. This is a national regulation on which ADHDcentraal has no influence
  • As of January 2022, the date of the consultation is decisive for your deductible. When a consultation takes place in 2022, this will count towards your deductible excess for 2022. The same applies in subsequent years: a consultation in 2023 will count towards your excess over 2023.

2022: Transition to a new funding system: the care performance model.

What does the transition to a new funding system in mental healthcare mean for you?

  • Our care will remain the same. What does change is the way the bill is drawn up. From now on you will be able to see exactly who you have spoken to during a consultation and how much time has been charged for it.
  • At ADHDcentraal we will tell you in advance how much time has been scheduled for your appointment. You will also see this in your patient portal. This way it is transparent in advance what you can expect. Only if the actual time differs by more than 15 minutes (more or less minutes than planned) will you see the duration adjusted on the bill.
  • If you have unplanned contact with your practitioner about the content of the treatment (for example, by telephone or via eHealth), you will see this afterwards. Here too, the bill will show exactly who the contact was with and how much time was charged.

Would you like more information about the national Care Performance Model in the GGZ? Download the following leaflet:

Payment

ADHDcentraal bills the costs of treatment to you or your health insurance company on a monthly basis. The settlement of invoices will depend on the agreements we have been able to make with your health insurance company.

  • If we have a contract with your health insurance company, ADHDcentraal can do the financial settlement directly with your health insurance company. There will be no personal contribution for the diagnostics and treatment. ADHDcentraal will inform your health insurance company of the costs of care on a monthly basis.
  • In the case of a payment arrangement with your health insurer, ADHDcentraal can do the billing directly with your health insurer. In these cases a personal contribution for the diagnostics and treatment is applicable. Infomedics will send you an invoice for the personal contribution. For treatments performed up to and including 2021, Famed will take care of this invoicing.
  • If there is no contract with your health insurer, you will have to receive the invoices from ADHDcentraal monthly and submit them to your health insurer. In these cases, the personal contribution also applies, which will be charged on the first invoice. On the basis of the reimbursement overview of your insurer that ADHDcentraal receives from you, we determine the amount of your personal contribution. In this situation, you will have to pay the invoice yourself.

Personal contribution medication

Medication has an important place in the treatment of ADHD. This medication will be prescribed by us and supplied by your pharmacist. Depending on the drug that is prescribed, a personal contribution may be required under the Health Insurance Act. This is legally maximized at € 250, -. Your insurer will charge you for this personal contribution. This goes beyond ADHDcentraal. It may be that you have additional insurance to cover these costs. Please check with your insurer. Some manufacturers have a refund scheme for this contribution. See the following links:

Referral

A referral from your general practitioner to the Specialist GGZ is required.

More information

Do you have any questions? We are happy to answer them. Please call us at 088 – 3131 200.

About the rates

The rates for the care provided by ADHDcentraal are in accordance with the NZa (Dutch Healthcare Authority) ruling.