Reimbursement for the treatment

For the medical specialist care of Karmenta, we aim that, with the exception of your deductible (own risk), which always applies, you do not have to pay anything yourself. However, this does depend on your health insurance. If your health insurance is properly and adequately reimbursed, your treatment at Karmenta will cost nothing more than in the hospital.

Check how the costs are handled with your health insurance provider.

Contract free care

Because Karmenta doesn’t have contracts with health insurance companies, we are free to offer the most women friendly care possible. Karmenta doesn’t have any limits to the amount of care we can offer, and the insurer doesn’t decide what care we can or cannot provide. This usually proves to be a great advantage to you as a patient of our clinic, because you have more freedom with your gynecologist to choose the treatment that suits you the best. A (small) downside is that the administrative side of things is a little bit more complicated than if you were to go to a hospital. 

How does Karmenta offer medical care?

Just like in a hospital, Karmenta offers both insured and uninsured care. It depends on how you are insured, whether your health insurer reimburses all or part of the treatment. If you receive care from Karmenta that your health insurance does not reimburse 100%, for example because you have a Natura insurance, the health insurance will charge you part of the costs of the treatment. You can request leniency from Karmenta for that (uncompensated) part. You can request this leniency with an online form. There are conditions attached to this, and we also check whether your health insurance has correctly determined the reimbursement. If not, we will help you to receive the correct reimbursement from your health insurance. The maximum leniency with which we grant you is a maximum of 20% of your invoice amount.

Exception: Pelvic physiotherapist and Menopause consultant

Karmenta works together with a pelvic physiotherapist and a menopause consultant. They work independently and invoice you for the care provided. Karmenta does not invoice for this care, and the information about the reimbursement can therefore differ for this care from the care provided by karmenta.

If you have had a consultation with one of them, you will also receive an invoice from them. Their care is often covered by the supplementary insurance, so not (only) by the basic insurance. The pelvic physiotherapist and the menopause consultant can provide you with detailed information about this, feel free to ask them during the consultation or when making an appointment.

Will my treatment be funded?

Karmenta's gynecological care is almost always insured care, which is covered by your basic insurance. Karmenta is a non-contracted insured healthcare provider. Karmenta invoices your insurer for your health care. Some insurance providers hinder our ability to go straight to them, by having a “cessie ban” for example, or because they don’t make payment agreements with contractless healthcare providers. In those cases you will get an invoice sent to you from us and you will have to declare it yourself to your insurer to apply for funding. If your health insurer does not reimburse the full amount, we use a leniency arrangement, we aim that you do not have to pay yourself. Click here to find out how your insurer handles things.

Your health insurance is your responsibility

Before you get medical care at any clinic, it is always your responsibility to see what kind of funding you are eligible for with your health insurance. It usually depends on the type of policy you agreed too.

Are you not sure? Then call your insurance company! And don’t call us, because we can’t (nor want to) keep up with every single health insurance provider’s requirements. If we suspect that your treatment (at least partly) won’t be covered by your insurance, we will bring this to your attention, and feel free to double check with us as well. 

Your ‘own risk’

Make sure to watch your ‘own risk’, which is at least € 385,= a year. You can also agree to a higher ‘own risk’ with your insurance, normally your montly insurance premium costs will be lower in that case. The ‘own risk’ applies for all medical costs you generate in a year and ‘own risk’ is an amount you will always have to pay yourself, before you are eligible for funding. 

So always check your policy and ‘own risk’ before you come to a healthcare provider for treatment!

Does Karmenta offer uninsured care?

Yes, sometimes we will give you an option for something extra with your treatment, like painkillers or an ultrasound without medical need (indication). That extra care won’t be covered by your insurance. If you don’t have those specific things in your policy, then that makes it uninsured care that you will have to pay for yourself. When we offer uninsured care there will always be communication with your doctor first and the employees of Karmenta can then offer you an indication of the cost. Since these are costs you will have to pay for yourself and you won’t get refunded for. If the uninsured care is rather complex, then we will be able to give you an estimate of the costs before you get the treatment, so you can decide whether you still want the treatment or not. For uninsured care you will receive an invoice at your home. In some cases you will be able to pay during your visit at the reception with a bank card. We unfortunately don’t accept cash.

I want to pay for the care that Karmenta provided myself, is that possible?

Yes, that is possible. If you aren’t insured in the Netherlands, for example, but in another country. You probably won’t have any dutch health insurance in that case. Or because you are receiving care that isn’t included in your health insurance. Or because you don’t want to use your insurance, or ‘own risk’ for the care. In all these cases the passerby rate applies and you can get an invoice for the received care.

See the prices for Karmenta’s treatment option on the passerby rate price list.

No-Show rate

If you are scheduled for the consultation hour of Karmenta, but you do not show up for your appointment without informing us 24 hours in advance, the costs for the consultation will be charged to you. More information.

Links 

• Dutch Healthcare Authority (NZA)