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Specialist mental health care

Reimbursement HollandZorg healthcare insurance 2019

  1. What is specialist mental health care?
  2. Referral required
  3. Healthcare insurance reimbursement in 2019
  4. Maximum rates for non-contracted care providers
  5. No statutory personal contribution
  6. Policy excess
  7. Where can you go?
  8. Request permission

Note: the information on this page gives an abbreviated outline of the reimbursement provided. You can only derive any rights from our insurance conditions.

1. What is specialist mental health care?

Specialised mental healthcare includes diagnosis and specialist treatment of (highly) complex psychological
disorders such as psychiatrists and clinical psychologists generally provide.

Specialist mental health care does not include:

  • the treatment of adjustment disorders following a far-reaching event or change;
  • help with work and relationship problems;
  • indicated prevention in case of depression, panic disorders, anxiety disorders and problematic alcohol consumption;
  • Care in the case of a psychiatric disorder or restriction if the insured is younger than 18.

More information on which treatments meet the the state of the art and practice can be viewed at our website.

2. Referral required

You will need a referral from a general practitioner, medical specialist, doctor for the mentally disabled, specialist geriatrics doctor, company doctor or youth healthcare doctor. This condition will not apply where any of the following is the case:

  • unforeseen care that cannot reasonably be postponed;
  • follow-up treatment required further to unforeseen care that could not reasonably be postponed;
  • treatment required further to the provision of care pursuant to judicial proceedings;
  • referral for the same problem from basic mental healthcare to specialist mental healthcare;
  • follow-up treatment for the same problem by the same healthcare provider;
  • treatment with the same healthcare provider following a change in diagnosis;
  • if you have reached the age of 18, continued treatment by the same healthcare provider;
  • if you have reached the age of 18, continued treatment by a practitioner in charge of the care process for adults, after having been transferred by a special education expert or NIP child and adolescent psychologist;
  • treatment for a period of more than one year.


Reimbursement for specialist mental healthcare by a noncontracted care provider is subject to our written authorisation, prior to you receiving the care. When applying for care you will need to send us a copy of a  report from the attending physician with the medical diagnosis/diagnoses, a description of the current problem and the medical need for in-patient stay.


For specialised medical mental care in combination with an in-patient say, you must obtain written authorisation from us for the second and third consecutive years before the you receive the care. You must  enclose a (copy of the) national checklist for prolonged medical mental care (LGZZ) with your application.

3. Reimbursement payable by your health care insurance in 2019

Your basic insurance entitles you to reimbursement for specialist mental health care.

 

Public Healthcare Insurance Reimbursement 2019
HollandZorg public healthcare insurance 100% from contracted health care providers

 

Supplementary Insurance Reimbursement 2019            
Start none
Extra none
Plus none
Top none

4. Maximum rates for non-contracted care providers

Do you see a care provider we have not made any arrangements with? In that case, the rates in accordance with the rates list for non-contracted care applies. If the rates of the non-contracted care provider are higher than our listed maximum rates, then the difference will be for your account.

5. No statutory personal contribution

There is no statutory personal contribution for specialist mental health care.

6. Excess

If you are aged 18 or older, the costs count towards compulsory and, if applicable, voluntary excess.

7. Where can you go?

The following care providers can provide specialist mental healthcare as the coordinating practitioner:

  • clinical psychologists;
  • a clinical neuropsychologist;
  • psychiatrists;
  • psychotherapists;
  • a specialist geriatrics doctor who works at an institution for the provision of specialist mental healthcare;
  • an addiction specialist who works at an institution for the provision of specialist mental healthcare;
  • a clinical specialist in geriatric medicine who works at an institution for the provision of specialist mental healthcare;
  • a specialist mental healthcare nurse who works at an institution for the provision of specialist mental healthcare;
  • a healthcare psychologist who works at an institution for the provision of specialist mental healthcare.

This is subject to the condition that the care provider has a quality status that is listed in the National Health Care Institute's Quality Standards Register.

 

Transitional arrangement
If you will reach the age of 18 in 2018 and are then receiving care from a remedial educationalist or a NIP child and adolescent psychologist, then these care providers may continue to provide the care as coordinating practitioners for a maximum period of 365 days, commencing on the day that you reach the age of 18.

 

Reimbursement for specialist mental care by a noncontracted care provider in combination with in-patient care
is subject to our written authorisation, prior to you receiving the care. You must enclose (a copy of) the treatment plan with your request.

 

Use our care guide to find a contracted care provider in your neighbourhood. For more information, call the Healthcare advise line: +31(0)570 687 123. Our expertly trained staff will be pleased to help you on your way.

8. Request permission

You will require our written permission for the reimbursement for specialist mental healthcare by a non-contracted care provider in combination with a stay, prior to you receiving the care. You must enclose a (copy of the) treatment plan with your application.

 

You can send a request for permission to:

 

HollandZorg

Medical Advisor

Antwoordnummer 30

7400 VB Deventer

No stamp is necessary

 

If your healthcare provider sends the request on behalf of you, then we would like to know that you agree. This can be done by putting your signature on the application.

 

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