Karmenta changes the leniency scheme

When you receive the invoice for Karmenta's medical care, you submit it to your health insurance policy and you will receive a reimbursement. However, health insurers often do not determine the reimbursement correctly. For years, insured parties with a policy in kind have received too low a reimbursement when submitting invoices from non-contracted healthcare providers (such as Karmenta). Health insurers must now change that. Karmenta is entitled to proper compensation. And that is why we are adjusting the leniency scheme.

 Sometimes Karmenta may send the invoice directly to your health insurer if you authorize us to do so with the deed of assignment. Then the health insurer pays the reimbursement directly to Karmenta.

The court rulings on the reimbursement of insured care always revolve around the question to what extent your health insurer may prevent you from choosing the care (doctor) you want for your complaint. Because that "free choice of doctor" is a fundamental right. The unlawful reimbursement from health insurers is not only a problem for you as a patient / insured person: because your reimbursement is too low, the health insurer wants you to pay part of your bill yourself. But that is also a problem for Karmenta, because we want to prevent you as a patient from having to pay extra money. We want to offer you better, more pleasant and faster care of high quality in our region, for a reasonable price.

Karmenta applies a realistic price level, comparable to the rates of all hospitals in the region. Karmenta is therefore not too expensive, and the health insurer must therefore simply reimburse the medical care, according to the policy conditions.

Recently, the judge has again ruled, on appeal, that health insurers must adjust their reimbursement policy. The question now is whether health insurers will also do this, but unfortunately we hear very little about it at the moment ...

We would like to help our patients receive correct reimbursement from their health insurer, so that they can also give Karmenta good reimbursement for the care. If your health insurer does not reimburse enough, we want to accommodate you by granting you leniency, up to a maximum of 80% of our invoice amount. However, some health insurers reimburse so little that you will still have to pay extra, and that is probably not according to the law. Karmenta would also like to help you. For example, with sample letters that you can enclose with your claim, so that you can explain to the health insurer how to correctly determine the reimbursement in accordance with the law. But also by taking (legal) action against your health insurer on your behalf.

You can therefore grant us permission to claim the incorrect (unlawful) unpaid part of the invoice from your health insurer on your behalf. You give us this permission with an online application form for the leniency scheme on Karmenta's website. To reinforce that claim, we will bundle the claims of several patients so that we can negotiate with the health insurer on behalf of a group of patients. We will also cooperate with other non-contracted clinics in the Netherlands for these claims. Karmenta does this in collaboration with the Free Doctors Choice Enforcement Foundation. You will understand that we try to keep the administration that arises as simple and clear as possible ...

This change will take effect for all Karmenta patients whose treatment has started (first consultation, opening of the DBC) since November 2020.

What will change in concrete terms?

• You will only receive leniency for your healthcare invoice from Karmenta if you request this leniency using the online form on our website. An e-mail, phone call, or submitting your expense report is not enough.
• If you do not request leniency, we assume that you will reimburse the invoice in its entirety within the payment term of 30 days.
• Each application for the leniency scheme will be assessed separately, you will be informed of the leniency granted
• You will only receive leniency if you explain to the health insurer how the Karmenta invoice should be reimbursed correctly (with the sample letter), and - if they do not - by transferring your claim to Karmenta for the correct reimbursement.
• Initially, Karmenta grants leniency up to 80% of the invoice amount. Secondly, if, after the (legal) negotiation, your health insurer reimburses Karmenta for a correct reimbursement of your health care bill, we can grant you leniency up to the rest of the reimbursed amount. This is expected to be higher than that 80%, so we expect you to get a refund.
• From the above date, we will ask you to enclose a letter with the health insurer with your claim. We will try to e-mail that letter already pre-filled in to you.

Karmenta will also retroactively claim correct reimbursement of all invoices from before 9 November 2020 from the health insurance companies.

In this way we hope that you as a patient of Karmenta do not have to pay extra for the care of Karmenta. Unfortunately it is complicated, but we would like to emphasize that this is caused by the health insurers and their role in the Dutch health care system.

We want to concentrate 100% on offering patient-friendly, accessible, top-quality care for women, and now also for men, in our region. And that we can continue to do that, even in the current exciting time with Corona, and grow so that we can help even more patients. We want to pay our attention to this, and not to administration and hassle with health insurers ...