Health Insurance: Reimbursement for Foreign Treatment

Questioner

Health insurance does not want to pay for foreign EU treatment even though it cost less and is at least as good. Dear Sir or Madame, I write in English as my Dutch is not the best. I wrote the headline with help of google. You can answer anyway in Dutch as i do read and understand well enough. Summary of the case: • I followed a treatment kind which several Dutch professionals recommended to do. The Dutch SGGZ to where I wanted to go first does not even have any clinic in the Netherlands but have sent me to South Africa or Italy and then receive a lot of money from my health insurance without further questions. • At the end I decided for a Spanish subsidiary of a Dutch SGGZ following the same program, which has one the best ratings in the Netherlands Zorgkaart and is 100% reimborsed • The costs were less than any comparable treatment in the NL • And it was easier for me to follow for language barriers • As I was in bad condition and couldn't wait I went into treatment and paid everything myself first, assuming that it would not be a problem to get a reimbursement from my insurance. • Insurance declines coverage for weird reasons while they would have paid a more expensive version if I had done it with any SGGZ which sends their patients abroad. • How can that make sense? Could you please advise what to do? What is my chance of getting this reimbursed anyway?

Lawyer

If you want to undergo treatment abroad, in most cases you will need to ask your insurer for permission. This often needs to be substantiated by statements from doctors, among others. Urgency needs to be demonstrated. If you fail to do this or do not ask for permission, reimbursement will often not be forthcoming. After all, the insurer will decide on the basis of your application whether there are no other options and will have to decide whether reimbursement applies. If you do not agree, you can first file a complaint with your own insurer and then file a complaint with the umbrella organization to which your health insurer is affiliated. If you would like help with this, you can contact me directly and without obligation.

Questioner

Good morning. Thanks for your answer, I understand what you wrote. I asked authorization for the treatment abroad just last minute because m conditions were quite bad and Insurance asked me so many documents which I did not have available that I could not take it and wait. I went in Spain to a clinic Triora, which is owned by Triora here in The Hague. They do exactly the same treatment. The treatment in The Hague is 100% reimbursed. If you say, that by not waiting for authorization, I lose every right for retribution from the Health Insurance, well, then I guess you can not help me. My logic was that by going into theDutch owned clinic, with same therapy and lower prices than what the Dutch company pay, I would be safe and that authorization would just be a formality issue. Nevertheless, can the insurance say that they pay nothing, or would they have at least bto pay the cost they would have had if I did therapy in the Netherlands? If yiu coukd answer on these questions I could decide if I want to proceed to claim this money back or not. Thanks very much

Lawyer

The policy conditions determine whether there will be a reimbursement for a foreign treatment as if the treatment had taken place in the Netherlands. It is therefore possible that there will be no reimbursement because the insurer is free to determine this itself. If there is a cooperation agreement with the foreign practitioner, there is often a reimbursement. If nothing is determined in the policy about this, I advise you to file a complaint with the insurer.