Fees and prices
The prices of weightloss surgery: The passerby rate
Passerby rates are the prices used for people not insured in The Netherlands. Most people do not have to deal with this because in The Netherlands it is mandatory to have health insurance. The prices do apply to people from abroad. The prices also apply to people who want an operation but are not entitled to reimbursement by the health insurance. They pay for the procedure themselves.
Reimbursement out of the basic package
Weightloss surgery is generally reimbursed out of the basic package of your insurance. This means that the health insurer pays the costs if you have the right policy (read below) and meet the requirements. The most imporant is the BMI (Body Mass Index)
A BMI of 40 or higher
Is je BMI 40 of hoger dan kom je meestal in aanmerking voor een vergoeding.A BMI of 35 or higer
Is je BMI 35 en heb je een bijkomende ziekte die samenhangt met je overgewicht dan kom je meestal in aanmerking voor een vergoeding.BMI 30 - 35
Is je BMI 30-35 dan kom je niet in aanmerking voor een vergoeding. Toch is ook dan een maagverkleining vaak wel een uitkomst.Wil je wel een maagverkleining maar is je BMI kleiner dan 35 dan kan je er voor kiezen zelf de kosten te betalen. Dan gelden ook de passanten tarieven.
Deductible health insurance (the 'own risk')
Remember that even if you are reimbursed by the health insurer, you always pay up to a maximum of € 385 per year yourself.
Reimbursement for lifestyle intervention: In principle, the screening before the operation is reimbursed from the basic insurance and from the supplementary insurance.
- For the internist, there is so-called contracted care: there is no contract, but there is a reimbursement. This reimbursement may be lower than with contracted care.
- The dietician, psychologist and occupational therapist are reimbursed from the basic insurance. The physiotherapist and remedial therapist from the supplementary insurance.
- If you do not have supplementary insurance, you may receive a bill from the physiotherapy and remedial therapist that you must pay yourself.
How does the reimbursement work?
1. Restitution policy: With a restitution policy you have free choice of care. This means that you are free to choose which healthcare provider you go to. It does not matter whether your health insurer has a contract with this care provider. You will always receive full compensation.
2. Combination policy: a combination policy is in between a restitution policy and a care-in-kind (natura) policy. With a combination policy, you cannot simply assume that you will always be reimbursed for everything. Some insurers do not have a contract with all healthcare providers. If you go to a non-contracted care provider, you will only be reimbursed the 'normal' rate. Often this rate is not enough to cover the entire bill. With a combination policy, only 75% of the bill is reimbursed. In the event of weightloss surgery, WeightWorks will pay for the part that is not reimbursed and that part will therefore not be passed on to you.
3. Care-in-kind policy (Natura policy): With an in-kind policy, your health insurer pays the healthcare costs directly. However, only the care provided by care providers with whom the insurer has a contract is fully reimbursed. So you should always go to a care provider with whom your health insurer has concluded a contract Because WeightWorks is a private clinic, the costs – even if it concerns care from the basic insurance – are not automatically reimbursed. In that case, permission must first be requested from the health insurer for the treatment to be carried out.
4. The budget policy: The budget policy resembles the care-in-kind (natura) policy. However, the supply of care providers with a contract is very small. With this type of insurance, check in advance which healthcare providers you can go to.
The budget policy is often the cheapest but gives the least freedom of choice. If you have a Budget policy, then, just like with a care-in-kin policy, permission must first be requested from the health insurer before carrying out the treatment.
As a new healthcare provider, WeightWorks currently does not yet have a contract with all health insurers. This means that we cannot always send the bill for your treatment directly to your health insurance. In that case, you will receive the invoice after 45 days, which you can then submit to your health insurer. Only for a few insurance companies we have the option to invoice the bill directly. These are: VGZ, Univé, IZA, ZEKUR, DSW en Aevitae.
The invoice you receive is sometimes higher than the reimbursement you receive from your health insurance. With a combination policy (and sometimes with a care-in-kind or budget policy) only approximately 75% is reimbursed. You then transfer the amount transferred by the health insurance to us. The part that is not reimbursed will be borne by WeightWorks and will therefore not be passed on to you, if you pay within 7 days of receiving the money from you insurance company and send us the specificiation within that date.
If you have a refund policy, the health insurer will pay 100% of the invoiced amount. In this case, you transfer the entire amount paid out by the health insurance to us.
Rates for surgery
Reimbursement code:
049999014
15C290
Gastric Bypass / Mini Gastric Bypass / Gastric Sleeve
€ 9.450,00
049999013
15C289
Gastric Bypass / Mini Gastric Bypass / Gastric Sleeve with one-day admission (without overnight stay)
Rates for screening and follow-up
049999016
15C291
Multidisciplinary screening
€ 640,00
049999010
15C286
Multidisciplinary screening and follow-up in year 1 and 2 after surgery
€ 640,00
049999016
15C291
Follow-up in year 3, 4 and 5 after surgery
€ 640,00
