The care performance model (Het zorgprestatiemodel)

The care performance model (ZPM) will be introduced on 1 January 2022. In the ZPM it has been agreed how your psychologist should charge for your treatment. And it has been agreed how the invoice should be paid. The ZPM is not about which care you receive or how you receive it.

You don’t have to do anything yourself. Your psychologist writes down all parts of the treatment in accordance to the agreements in the care performance model. The practice sends regularly and in a safe way the invoice to you or your health care insurer.

The sessions you have with your psychologist are called care performance (zorgprestaties) in the ZPM. The care performances will be on the invoice your psychologist will send to your health care insurer. Based on this, the health care insurer knows what to pay to your psychologist.

On the invoice overview of your health care insurer you can see which care performance your psychologist has given you. You can find the invoice overview at “my surrounding” of your health care insurer website or app. Or you find the overview on paper from your health care insurer. Your insurer can help you to understand the overview. Also, if you do have questions about the care performance, please contact your health care insurer.

What care performances are there?

There are different types of care performances: Praktijk voor Psychologie works with care performance “consultations” (consulten). Consultations are the conversations, in person or online, that you have with your psychologist. Sometimes something extra is needed during a consultation, such as travel time because your psychologist was at your home. These care services are called ‘allowances’ (toeslagen). These will be added to a consultation if applicable. Finally, there are some ‘other achievements’. For example, a ‘peer consultation’ by your psychologist.

Costs and deductibles

When your treatment starts it is not immediately clear how your treatment will develop or how long it will last. That is why it is usually not known in advance how much your treatment will cost in total. However, it is clear in advance how much each part of the treatment costs. A price has been agreed for each separate part of the treatment (the care performances). The government has calculated the maximum cost of each care performance. There are many different rates. This is because the following factors have been taken into account when determining the rates:

• The profession of your caretaker.
• The type of consultation. A diagnostic consultation is more expensive than a treatment consultation.
• The duration of the consultation. The longer the consultation lasts, the more it costs.
• The place where the consultation takes place. Praktijk voor Psychologie is an independent practice. The consultation rates here are lower than in a specialized institution. In the rate finder https://zorgprestatiemodel.nza.nl/ of the Dutch Healthcare Authority (NZa) you will find all maximum rates. These maximum rates will be send to the health care insurers with which Praktijk voor Psychologie does not have a contract with.

Every year Praktijk voor Psychologie negotiates with various health care insurers for a contract for the coming year. A consideration has been made between the advantages and disadvantages for you, the client, and for the psychologist. The advantages of having a contract is that you as a client receive a higher reimbursement for the care received. The invoice will be sent directly to your health care insurer, so you don’t have to worry about the invoice. The disadvantage for the psychologist is that each health care insurer makes its own choices and rules with which the care and the organization must comply, as well as the rates that are offered to the psychologist. After making these considerations, Praktijk voor Psychologie had to decide not to conclude a contract with a number of health care insurers for 2022.

Praktijk voor Psychologie has no contracts with the following health care insurers:

DSW (7029), InTwente (3344), Stad Holland (7037), ASR (De Amersfoortse (9018), Ditzo (3336), Caresq; Aevitae Uzovi (3360), Care4Life (3360), ENO (Salland; HollandZorg; Zorgdirect (3347), Zorg en Zekerheid (7085), AZVZ (7085), ZEM (7085), ONVZ/ PNOzorg/VvAA (3343).

Praktijk voor Psychologie does have contracts with the following health care insurers:

Univé / ZEKUR (0101), ZEKUR natura (3361), VGZ (7095), IZZ (7095), Bewuzt (7095), UnitedConsumers (7095), MVJP (7095), Zorgzaam Verzekerd (7095), IZA (3334), UMC (0736), Zilveren Kruis (3311), ZieZo (3311), Pro Life (3311) ; Interpolis (3313); • FBTO (3351); De Friesland Zorgverzekeraar (3358), Menzis (3332), HEMA (3332), VinkVink (3332), Anderzorg (3333), CZ; Just, direct (9964), OHRA (9664), Nationale Nederlanden (9664)

You will notice that on your cost overview of your health care insurer with whom Praktijk voor Psychologie has a contract, you will find different rates. This is because the health care insurer with which we have a contract with, reimburses us lower prices. Would you like to know which prices apply to you exactly? Please contact your psychologist or your health care insurer.

Payment

If you are 18 years or older, your mental health care treatment is usually reimbursed from the basic package of your health care insurance. To be eligible for reimbursement, you need a referral from your general practitioner/specialist. With the insurers with which Praktijk voor Psychologie has a contract, Praktijk voor Psychologie will send the invoice on a monthly basis directly to the health care insurer. If Praktijk voor Psychologie does not have a contract with your health care insurer, you will receive a monthly invoice that you must pay fully to Praktijk voor Psychologie, regardless of the reimbursement you receive from your health care insurer. You can then submit the invoice yourself to your health care insurer. Your health care insurer will then reimburse (part of) the costs.

Praktijk voor Psychologie tries to inform you as well as possible about this. However, the responsibility for checking whether and how much your insurance policy reimburses for the treatment lies with you as a client. You should familiarize yourself with the policy conditions. If, after the treatment has been completed, it appears that the treatment is not/not fully reimbursed, the (remaining) invoice for the treatment will be charged to you. So ask your psychologist and your health care insurer whether your treatment will be reimbursed before you start the treatment! Praktijk voor Psychologie cannot be held liable if treatment turns out not to be reimbursed by your insurance company, for example because you have opted for a reduced basic health care insurance or have already made use of psychological care. Praktijk voor Psychologie also cannot submit invoices to the health care insurer without a referral letter. Costs that cannot be claimed under health care insurance will be charged to you.

Deductibles

From the basic health care insurance package you pay a deductible for many types of care that are reimbursed. How is the deductible for mental health treatment calculated? The deductible is calculated per calendar year. 2022 is a calendar year. And 2023 is a new calendar year. Your health care insurer calculates whether you have to pay a deductible. In the care performance model, treatment is made up of separate components: care performances. One conversation with a psychologist, for example, is one single care performance. The health care insurer includes the health care performances that take place in 2022 in the calculation of the deductible for 2022. The health care performance that take place in 2023 are included in the calculation of the deductible for 2023.

An example: in 2022 you will have 8 conversations with a psychologist. And in 2023 you will have 2 conversations with a psychologist. The 8 conversations that take place in 2022 count towards your deductible for 2022. The 2 conversations that take place in 2023 count towards your deductible for 2023.

Whether you also have to pay your deductibles as a result of your mental health care treatment depends on several things: Did you have other health care costs in the same year that were part of the basic insurance? For example medication or treatment in a hospital? Then you may have already paid your deductibles. Or part of it.

Did you opt for a voluntary deductible when signing your insurance contract? Then the deductible amount is higher for you. The statutory deductible for this year is 385 euros. The maximum deductible is 885 euros (500 euros on top of the mandatory deductible). If you opted for a higher deductible amount, you will pay a larger part of your health care costs yourself. Would you like to know more about your deductible? Or are you worried about whether you can afford it? Please contact your health care insurer.

“No Show”

Health care insurers reimburse only when a treatment has taken place. Are you suddenly prevented from coming? Phone or mail at least 24-hours in advance to the practice. Appointments that are not cancelled in time or are not complied with, will be charged at the full rate of €115.00 per consultation.

Note that you must pay within two weeks after which default occurs without warning.

If you would like more information about the care performance model, please visit https://www.zorgprestatiemodel.nl/