Insured Care

Basic insurance policy

During the first consult I can tell you if an intervention is covered by the basic insurance policy. Generally the insurance company’s common concern is, if one can speak of functional complaints. A breast reduction, for example, is covered by the basic insurance policy because heavy breast cause neck - and shoulder complaints. But also congenital defects qualify for compensation. Interventions that exclusively improve the shape of the body (ear corrections, eyelid correction, abdominal wall correction, breast lift etc.), fall outside the basic insurance policy and have been excluded from compensation.

Additional policy

On 1 January 2006 the basic insurance policy became effective for all patients who were enrolled in the national health insurance and all privately insured people. If all goes well, nothing will change in the total care plan of privately insured people. All care packages, which were included above the standard package in the old private policy, are transferred to an additional policy. For patients who where insured by the national health insurance, only exclusively the basic insurance applies. As from 1 January 2006, and where it concerns plastic surgery, the package is more limited than it used to be. Patients insured through the national health insurance with a special higher insurance on top of the basic coverage however, get just like privately insured people, an additional policy.

As a plastic surgeon it is impossible for me to keep up with what treatments will or will not be covered under the many additional policies. In practice it will be that I, in principle, will request every intervention from your insurance when you have an additional policy.

Request

I send a request to your health insurance company by means of a letter. In that letter I propose the case as it is. With that I mean, that I cannot help you in making your case more serious than it is, because if I would do so I put my reputation with the health insurance company at risk. The insurance company deals with the application in writing, or, the medical advisor invites you for a consult to assess the request. If the request is accepted and an authorization for compensation is received, the treatment can proceed as planned according to the legally determined tariffs: the treatment comes then under the insured care policy. You will either receive the bill yourself, whereupon you can submit it for compensation to your insurance company, or the bill will be sent to your health insurance company directly. In the first instance you have a restitution policy; in the second case you have a "natura" policy. If the request is denied, then it will be advisable to see if the insurance company has looked at the request carefully enough. The best scenario is that a medical advisor deals with your request and evaluates your complaint during a personal consult.

You have to pay yourself

If the surgery will definitely not be compensated, then you can still have it done by paying for it yourself. The treatment then falls under the not- insured private care. If you wish to have it done in this manner I can present you with an offer, which consists of the total amount for the complete treatment. After treatment is started under private care, it is impossible to submit a request to the health insurance company for (partial) compensation.