There is a lot of uncertainty about reimbursement of care

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A striking number of people this year have a question about the reimbursement that their health insurance provides for treatment, reports the Health Insurance Complaints and Disputes Foundation (SKGZ). It is not known exactly which figures are involved, because the foundation does not keep track of that, but a spokeswoman does speak of ‘a strong increase’ in the number of questions compared to recent years.

Healthcare providers, such as hospitals and physiotherapists, receive money from insurers for providing healthcare. Agreements about this are laid down in a contract. For many health insurance policies, care at an institution is only fully reimbursed if that insurer has a contract with that organization. Otherwise, the patient must pay part of it himself.

Rough conversations

The contracting should actually be completed before the end of the year, because people can still switch health insurers then. It must therefore be clear who reimburses which care. But in recent years, conversations have become less and less easy. One of the reasons for this this year is inflation. Some hospitals reported in mid-February that a contract with all insurers was still not complete.

People report to the SKGZ who, when they switched, did not know which care provider reimbursed the care in full and which only partially reimbursed it. If an insured person is ‘disadvantaged’ due to the late notification of an agreement between the care provider and the insurer, the SKGZ can see whether mediation by the Healthcare Insurance Ombudsman is possible. The Health Insurance Disputes Committee can also ultimately issue a binding recommendation on a case, a spokeswoman said.

Never before have so many people switched health insurers as this year. Switchers often take a critical look at the reimbursements that an insurer offers, the spokeswoman explains. For this reason and also because the contracting between insurers and healthcare provider is so difficult this year, the SKGZ expects the number of complaints to be extra high in 2023. It may take a while before the foundation knows how many official complaints have been submitted this switching season. Before the SKGZ can handle a complaint, people must first submit the complaint to their health insurer.

The Laurentius Hospital in Roermond indicates on its website that no agreement has yet been concluded with several insurers. The hospital says it ‘continuously’ points out to patients that not all examinations and treatments are automatically reimbursed. Patients are advised to check their insurance before treatment.

Health insurers in the Netherlands say they find the lack of clarity for patients ‘very annoying’. A spokeswoman also advises patients to talk to their own insurer if they have any questions.

NIJMEGEN – A patient is wheeled into a hospital bed for a nurse. (ANP / Robin Utrecht / Holland Height)
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