FEES

Own risk

Everyone is obliged to make their own contribution to healthcare costs. This is also referred to as the ‘own risk’. This amount is at least € 385 per year and you always pay this to your health insurer when you incur costs that fall under basic care. Once you have paid your deductible, you will not be charged for insured care for the rest of the year. To lower the monthly costs for your health insurance, you can voluntarily opt for a higher deductible, up to a maximum of € 850 per year.

Not all insured care is subject to the deductible. No deductible has to be paid for care from your general practitioner and care for children up to the age of 18.

Frequently asked questions about insured care

Why do I only receive my invoice so long after my first consultation with the sports doctor?

A care process is opened during the first consultation. It has been established by law that this care process will be closed after 90 days. Only then can the invoice be drawn up. After the conclusion of a first care process, a follow-up process starts automatically. This follow-up process takes 120 days. This is followed by two follow-up courses of 120 days. Here too, the invoice will only be sent to you at the end of the follow-up process.

How is the amount of the invoice determined?

As required for specialist medical care, the bill is structured according to the Diagnosis-Treatment-Combination (DBC) system. The amount of the invoice depends on the number of consultations you have had and the number of procedures/examinations that have taken place. Roughly speaking, the following rate groups can be distinguished:

1 or 2 consultations in case of an injury/complaint of the musculoskeletal system	€182 – €205
3 or more consultations in case of an injury/complaint of the musculoskeletal system	€399 – €415
1 or more consultations in case of an injury/complaint of the musculoskeletal system + additional examination (MRI, ultrasound)	€525 – €560
1 or 2 consultations for an exercise-related complaint (e.g. fatigue, shortness of breath, dizziness, chest pain)	€257 – €265
1 or more consultations for an exercise-related complaint (e.g. fatigue, shortness of breath, dizziness, chest pain) + exercise diagnostics	€615 – €642

Why is there a different specialty on my invoice?

You have been treated by the sports doctor. Nevertheless, the invoice may contain a mention of another specialism, such as orthopedics or internal medicine. Or you will find a deviating description on your claim (for example: “1 or 2 outpatient clinic visits in the event of an injury to the musculoskeletal system”). This is because no separate sports medical diagnoses have been developed in the DBC system for sports physicians. The sports doctor therefore uses the diagnoses that the other medical specialists also use.

Will the bill be reimbursed by my health insurer?

Consultations by the sports doctor fall under basic care and are therefore reimbursed from the basic insurance. Sports doctors who are not employed by a hospital cannot always conclude a contract with all health insurers. This also applies to Jessica Gal Sports Doctors. The care is therefore referred to as “non-contracted care”. Health insurers do not always reimburse “non-contracted care” in full. The amount of the reimbursement for non-contracted care depends on your insurer and the policy you have taken out (reimbursement policy or in-kind policy). In this case, the reimbursement will be between 60% and 100% of the costs, taking into account the deductible.

If you are unsure about the reimbursement, we advise you to contact your health insurer. When you submit your invoice to the health insurer, you will automatically be informed which reimbursement applies to you.

Why does it say ‘Sportklinieken Nederland’ on my invoice?

Your invoice will be sent on behalf of Stichting Sportklinieken Nederland. This is the Independent Treatment Center under which Jessica Gal Sportartsen falls.

Why do I receive my invoice from Infomedics?

If we do not have a contract with your health insurer, you will receive the bill from Infomedics. This is the organization that supports us in our invoicing. You pay the invoice to Infomedics and can then submit it to your health insurer. Are you insured with a contracted health insurer, or do you have a health insurer with reimbursement policies only? Then we will send your invoice directly to the insurer.

With which health insurers has a contract or payment agreement been concluded?

• Zilveren Kruis Zorgverzekeringen N.V., statutair gevestigd te Utrecht, (inclusief Pro Life Zorgverzekeringen) (3311)
• Interpolis Zorgverzekeringen N.V., statutair gevestigd te Utrecht (3313);
• FBTO Zorgverzekeringen N.V., statutair gevestigd te Leeuwarden (3351);
• De Friesland Zorgverzekeraar N.V., statutair gevestigd te Leeuwarden (3358).
• Achmea Zorgverzekeringen N.V., statutair gevestigd te Zeist.

 Questions?

If you have any questions please call 088-2290999 or mail to [email protected]

DBC’S en Zorgproducten
Om de kosten voor de aan jou verleende zorg te bepalen wordt gebruik gemaakt van DBC’s (Diagnose Behandel Combinaties) en zorgproducten. Dit zijn alle handelingen die onderdeel uitmaken van jouw behandeling, bijvoorbeeld een eerste consult bij de sportarts, een echo of MRI, een injectie of behandeladvies, en een herhalingsconsult. Dit geheel aan activiteiten wordt een DBC zorgproduct genoemd.

Omdat er meestal enige tijd overheen gaat voordat een diagnose is gesteld en de behandeling is afgerond, wordt het DBC zorgproduct pas na 90 dagen ‘gesloten’ waarna de factuur kan worden opgemaakt.

Passantentarieven
Indien wij een contract of betaalovereenkomst hebben met je zorgverzekeraar, dan wordt jouw factuur direct naar je zorgverzekeraar gestuurd. In sommige gevallen kan de factuur van je behandeling niet rechtstreeks bij je zorgverzekeraar worden ingediend. Bijvoorbeeld als je niet in Nederland bent verzekerd, of als er geen contract of betaalovereenkomst is met je zorgverzekeraar. In deze gevallen kan je gewoon worden behandeld, maar ontvang je de factuur zelf. Je dient deze te voldoen en kan deze aansluitend indienen bij je zorgverzekeraar.

De tarieven die hierbij gehanteerd worden, worden passantentarieven genoemd. Deze passantentarieven worden jaarlijks vastgesteld. Om je een indicatie te geven van de kosten die je kan verwachten, vind je hieronder een link naar de passantentarieven.

De passantentarieven voor 2021 vindt u hier.

Wanneer je een restitutiepolis hebt, dan wordt (na aftrek van je eigen risico) 100%  van het passantentarief dat door de verzekeraar gehanteerd wordt vergoed. Wanneer je een naturapolis heeft, dan wordt minimaal 70% van dit bedrag vergoed. Wij adviseren je voorafgaand aan je consult de voorwaarden van je verzekeringspolis te checken bij je zorgverzekeraar.