Resolving health insurance issues

Questioner

On the advice of our dentist, an appointment is made with the orthodontist for a second opinion on whether braces are necessary for my son (born in 2003). This appears to be the case. On the advice of the orthodontist, I consult a website to gain insight into which health insurer offers the highest cost coverage for the orthodontic treatments that my son will have to undergo. I end up with a Zilveren Kruis three-star insurance policy and ensure that my son can start the treatment in 2016 under the latest interesting policy. I spend a lot of time researching and also consult the Zilveren Kruis helpdesk to be sure of the right insurance. In April, I receive reminders because the submitted claims for the treatments that have already been carried out are rejected by Zilveren Kruis. After some research, it turns out that I have not requested an additional three-star, but a three-star dentist. Orthodontics does not fall under this, the helpdesk emails me after I asked why the claims are being rejected. Since I have never needed dental insurance (never needed treatment) and my child is listed for free with the main insured (initially with father who is insured with Menzis) a three-star dentist is a remarkable change in my policy. My question to you is whether a health insurer in a case like this realizes that the choice was made in a very unfortunate way for the 'wrong three-star' and whether you have experience to what extent a health insurer is lenient enough to still change the policy in this current year. In the meantime I am more than 1400 euros poorer and the treatments have just started...

Lawyer

Experience shows that health insurers are in principle unforgiving when it comes to reimbursements that are not covered. Especially if the mistake of the application is yours. However, you can ask the health insurer for leniency by means of a letter, in which you explain the seriousness and the situation and state that it is a mistake and that you are now saddled with the costs. Nothing ventured, nothing gained, but as mentioned, health insurers are strict in these kinds of matters. For further assistance, you can contact me directly and free of charge.

Lawyer

The terms used for the various insurance coverages can of course be quite confusing and misleading in themselves (this can constitute an unlawful act/breach of contract). But in the first instance the fault lies with you and you will have to refute the above with reasons, which is quite difficult.