frequently asked questions about the reimbursement of Karmenta's healthcare invoices

We would like to inform you about some business aspects of the medical care at Karmenta.

Karmenta is a so-called non-contracted healthcare provider of specialist medical care, which is almost always covered by the basic insurance of your health insurance.

Karmenta has no contracts with health insurers. As a result, claiming Karmenta's medical care is a bit different than in a hospital.

Below we answer frequently asked questions about the reimbursement of Karmenta's healthcare invoices.

I was referred to Karmenta by my doctor. Is the care I receive at Karmenta covered by my health insurance?

Yes.

In order to be eligible for reimbursement by your health insurance, you need a referral from your general practitioner, just like with the hospital.

In addition, in consultation with your gynecologist, you can sometimes combine uninsured care with insured care at Karmenta. Uninsured care is of course not covered by your health insurance and you have to pay yourself.

Do I receive an invoice at home for the medical care of Karmenta?

If your health insurer allows it (check the policy-terms of your insurance) and you give us permission to do so with a deed of assignment (on the website, or on paper), we can send the health care invoice directly to your health insurance and your health insurer also pays directly to Karmenta. That is of course the easiest administratively. There are health insurers that do not allow this. In that case, you will receive the healthcare bill at home and must declare it yourself to your healthcare insurance policy. The health insurance will send you a statement overview and usually pay quickly, so that you can pay Karmenta again within the payment term.

Read how your health insurance has arranged it.

Is the medical care at Karmenta 100% reimbursed by my health insurance?

This of course depends on the health insurance you have taken out. And of course the legally required deductible of at least € 385,= applies. With a refund policy ("restitutiepolis") you have the fewest problems, usually such an insurance reimburses (almost) 100% of our care bill. With a policy in kind ("naturapolis"), the reimbursement is lower, usually 75% of a “competitive” rate set by your health insurer. The reimbursement is even lower for budget policies.

So I still have to pay?

The reimbursement of your health insurance may not be legal, in accordance with the law. Various lawsuits have been and are being conducted about this. More clarity about this will hopefully follow this year. On Karmenta’s website you will find the current information (see latest news). You as a patient, and Karmenta as a care provider, are entitled to a reasonable reimbursement for the care provided, so that Karmenta can continue to offer the care in the future. Until there is more clarity, you may have to pay part of the invoice yourself to bridge the gap. And that you will receive a separate invoice for this, after assessment of your leniency application.

Leniency scheme

Karmenta uses a leniency scheme to compensate you for the amount that is not reimbursed by your health insurance. The leniency amounts to a maximum of 20% of the amount on Karmenta's care bill. You are only eligible for this leniency if you fill in the application form on the website.

I have a "restitutioninsurance", how much will I get reimbursed?

If all goes well and your health insurer complies with the law, you will be reimbursed 100% of Karmenta's bill. However, many health insurers reimburse up to an “average contracted” rate set by them, and that is not allowed. It has been prohibited by the court, but health insurers still do it.

If you have such health insurance, you can request leniency for the non-reimbursed part of Karmenta's invoice.

You must always apply for leniency with the online form on the website. Each application is assessed by our healthcare administration and you will be notified.

You transfer the claim for the non-reimbursed part to Karmenta, and we will claim that amount from your health insurance. If we have received it, we will settle it against the leniency we initially granted.

I have "naturainsurance", how much will I get reimbursed?

If you have opted for natura-insurance, you often pay a lower premium. In order to control healthcare costs, your health insurer would therefore prefer that you purchase the care from care providers with whom they have a contract.

If you have such an natura-policy, you will only be reimbursed a limited part of the costs from non-contracted care providers - such as Karmenta. Usually that is about 70% of an amount that that insurer uses as "market conform" and then the non-reimbursed part of your invoice can become quite large. Up to 40 percent, depending on the health insurance policy you choose.

You can read the percentage that your health insurance reimburses in your health insurance policy. Part of Karmenta's invoice is therefore not covered by the reimbursement of your health insurance, so you have to pay part of the invoice yourself.

Whatever health insurance you have, your health insurance should not reimburse so little that you are in fact forced to go to a contracted health care provider. This has been prohibited by the court, but health insurers still do it.

If you have such health insurance, you can request leniency for the non-reimbursed part of Karmenta's invoice. You will then receive leniency up to a maximum of 20% of Karmenta's invoice amount.

You must always apply for leniency with the online form on the website. Each application is assessed by our healthcare administration and you will be notified.

When you complete the form, you also transfer the claim of the unpaid part to Karmenta. We will discuss with your health insurance a correct reimbursement of Karmenta's invoice. This consultation may take a while, but in the end we assume that the health insurer will reimburse the invoice correctly and pay it to Karmenta. And then Karmenta will repay / settle the amount that you had to pay earlier yourself.

We cannot yet predict when and whether you will be refunded. Nor can we predict yet whether Karmenta, probably jointly with other clinics, will claim and receive this amount from all health insurers (including the little ones).

In the coming period, we expect health insurers to adjust their reimbursement policies. They now also have to do that from the judge.

Our goal is, and remains, that you do not have to pay extra for care at Karmenta.

What will my treatment cost?

That is a difficult question, because of course you go to the medical specialist to find out what you have. And once that has been established (diagnosis), you and your doctor choose the right treatment for your complaint.

The various care activities that together form your treatment (diagnosis treatment combination) ultimately lead to a care product and a price depends on it. Our invoice for your care product contains an amount, which is the passer-by rate. You can look up the different care products in the list of gynecological and urological care products.

More information about how the price of a care product is determined at Karmenta.