Reimbursement from 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 fully reimbursed*. 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 when you are insured with these insurers. In case of doubt, please contact your health insurance company to find out if they 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 leniency regulation* applies 

You can find information about your type of policy in your policy conditions.

*You have to pay your outstanding deductible if applicable. This applies to all care providers within the Specialist Mental Health Care. For further information, read under the heading ‘Own Risk’.

Contracts with health insurers

To make our care as accesible as possible, ADHDcentraal strives to conclude contracts with as many insurers as achievable. However, not all insurers offer a contract which allows us to treat a sufficient amount of patients/insurers.

Unfortunately, not all contracts can be closed before the start of the new year. In the table below, we showcase the most recent contract status. This table will be updated when new contracts are closed.

If you are insured with one of the insurers with which ADHDcentraal has a contract, you do not pay a personal contribution. You do need to pay any outstanding deductible.

Leniency regulation for healthcare costs

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 will also need to pay a portion of the costs yourself: the personal contribution. If you come to us for treatment after the diagnosis day, the personal contribution is EUR 250. If we refer you back to your GP after the diagnosis day, for example because the diagnosis of ADHD cannot be made, a reduced personal contribution of EUR 100 applies. In practice, your costs for treatment at ADHDcentraal will never exceed EUR 250 (plus any outstanding deductible, see below under the heading ‘deductible’).

The date of the diagnosis day determines whether a personal contribution applies to you.
NB. With or without a contract, in all cases the statutory deductible will be used in full if you attend the diagnosis day and/or are under treatment.

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.

• 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

How does the transition to a new funding system in mental healthcare affect you?

• Our care will remain the same. What does differ 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.
• At ADHDcentraal we will inform you in advance how much time has been scheduled for your appointment. You will also be able to 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 contents of treatment (for example, by telephone or via eHealth), you will be able to see this afterwards. Here too, the bill will show exactly who was contacted and how much time was charged

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

• Patientfolder- zorgprestatiemodel
• English version: Flyer “Zorgprestatiemodel”

Payment

ADHDcentraal bills the costs of treatment to you or your health insurance company on a monthly basis. The settling 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 will be able to 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.
• If there is no contract with your health insurer, you will receive the invoices from ADHDcentraal monthly via Infomedics and submit them to your health insurer.  On the basis of the reimbursement overview of your insurer that ADHDcentraal receives from you, we make a calculation. The amount you have to pay Infomedicsis the reimbursement from your insurer, any outstanding deductible and a maximum personal contribution of € 250.00. For more information click hier.

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 medication prescribed, a personal contribution might be necessary under the Health Insurance Act. This is capped at €250 by law. The personal contribution will be charged to you by your own insurer. This will not involve ADHDcentraal.
You may have supplemental insurance for these costs. Inquire about this with your insurance company. Some manufacturers have a refund scheme for the personal contribution. See the following links for more information:
Terugbetalingsregeling Tentin
Terugbetalingsregeling Elvanse

Deductibility of medical expenses

Healthcare costs may be deducted in the tax declaration under certain conditions. You will find more information about this here: hier.

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. (NZa)