IVF buitenland - verwijzing

Hi!

I have a question about IVF abroad - in Portugal.

I'm in a special situation. More than a year ago, I discussed with my huisarts that I was having some difficulty getting pregnant. He advised to relax and keep trying because I already had a child, so another should not be a problem.

Fast forward and it's been 25months trying and I find myself in Portugal due to the pandemic. I didn't want to wait to return to NL so I went to a fertility specialist in a hospital here in Portugal. Made all sorts of exams for fertility at the hospital and started treatments (I did not and wlll not try to get any reimbursement for these from zilveren kruis). 

We've reached a point where the specialist is recommending IVF. For the IVF procedure I would like to claim reimbursement but I have some doubts:

  1. I'm trying to figure out if basis zeker is sufficient or if I should have exclusive. In this table, the right column says an amount but I don't understand if that's the maximum amount refunded or if it will be 75% of that? https://www.zilverenkruis.nl/-/media/zilverenkruis/files/consumenten/veelgesteldevragen/niet-gecontracteerdezorg/tarievennietgecontracteerde-zorg/tarieven-niet-gecontracteerde-zorg-2021/tarieven-medisch-specialistische-zorg-2021.pdf
    1. Maybe easier with an example. let's say i have basis zeker and get an invoice for 900€ under verricthing 14b182. What is the refund amount?

2. About the authorization process, I see I need to provide a verwijzing. Can this be a from the portuguese fertility specialist? If not, what exactly do I need - hopefully there is some understanding that I am not in the Netherlands and no physical presence in the Netherlands will be required. What languages can the reports be in? Can it be portuguese? Can the translation be to english (easier to find translator) or should it be to dutch?

  • Offline

    Good afternoon Hrachao,

    First of all welcome on Samen! Good of you to check what the possibilities are for an IVF treatment abroad. The Basic Insurance covers IVF attempt for woman we are younger than 43. Specifically it covers 3 attempts per continues pregnancy. You’ll find the overview of the (Dutch) terms here:

    https://www.zilverenkruis.nl/consumenten/vergoedingen/ivf

    At a contracted provider we cover the costs fully except for the mandatory excess, provided a person is below 43 years of age, referred to the hospital by a general practioner or medical specialist, and the specialist agrees to the treatment.

    At a non-contracted provider (like a provider abroad) we would cover a maximum of 75% of our contracted rates from the Basis Budget of Basis Zeker, or 100% of the Dutch rates from the Basis Exclusief.

    An important part for you is that for a treatment in Portugal we can only determine if the treatments are covered if you file a request with our department for health care costs abroad. Provided that you are below 43 years of age of course. The request is a requirement for us before we can tell you if the treatments are covered, and if so for which rates.

    While filing a request is not obligated, it is something we always advise to do when you plan a treatment abroad for the reasons given above. You file a request through this form of our website:

    https://www.zilverenkruis.nl/consumenten/formulieren/machtiging-buitenland-check

    We need a referral from a general practioner, details of the care provider, treatment plan and a cost overview to evaluate the request. For help with the request and general questions about the treatment abroad you can contact the department on +31 71 365 04 50 (businessdays 08:00 -18:00 Dutch time).

    Another important choice for you is to decide which Basic Insurance you want to take for 2021. The Basis Exclusief offers the highest coverage for non-contracted care. You can change your Basic Insurance with us on 31 December 2021 at the latest for next year. However because we need to evaluate the request for the coverage I unfortunately can’t give you a guarantee that the treatment in Portugal will be covered. If you opt for the Basis Exclusief let us know in time.

    Does this information help Hrachao? Let us know if you have any further questions.

    Bart

  • Offline als antwoord op barth:

    this website is not working properly. Already replied 2 times and it gives a "fout" because it logs me out...

    Thank you for your clarifications, much appreciated! I would like a more direct answer to my question nr 2, which is my main question - the subject of this is "verwijzing".

    We need a referral from a general practioner, details of the care provider, treatment plan and a cost overview to evaluate the request

    You mention "a referral from a general practitioner". What does this mean??

    You did not say "your family doctor" so can it be any doctor? Can it be a Portuguese doctor?

    I contacted my NL huisarts and she says that since I'm already being followed by a fertility specialist/gynocologist, then they should be the ones doing a referral to IVF.

    But if what is required is a verwijzing from my NL huisarts, she wants to understand what she needs to write about? Is it just a letter that taking into account my medical hystory, she refers me to a fertility specialist/gynecologist? It does not make sense that my huisarts would be the one to directly refer me to IVF.

    The unclarity about this verwijzing is giving me a lot of stress. I need to understand exactly what is needed because for me, I'm already at a specialist/gynecologists' who states I should go do IVF now. So that's the most medically accurate verwijzing but it would come from a PT doctor. But if your procedures only take into account that you first want a referral from my huisarts to a fertility specialist, then that's what I'll get from her!

    HELP!

  • Offline stelde een antwoord voor als antwoord op hrachao:

    Unfortunately Samen logs you out relatively quickly! It’s a known issue on our platform at the moment. We’re looking at ways to fix this. In the meantime, it’s best to write down your message in a Word-document or note first.

    A general practioner (GP)  is the English term for ‘huisarts’ in Dutch, or ‘family doctor’ as you’ve translated it. The GP gives you the referral for making the first appointment in the hospital. If you already have this, you do not have to ask for a new one. When you’re in the hospital, a specialist like a gynaecologist is the one that actually refers you for IVF treatments.

    To clarify: to request a coverage with us we ask for a referral from a general practioner that pointed you to the hospital. All the other information that we need is part of the treatment plan, costs overview and so on.

    I recommend that, if you’re able to, contact our department for health care costs abroad Hrachoa. They are the ones who are going to evaluate your request, an can talk you through all the questions you may still have. Hopefully they can put your mind at ease.

    Bart

  • beste Hrachao,

    I send you a link to a big file of all the reimbursements for all types of codes, divided in Restitutie and Natura, and a screenprint of the page of 14B182. So you can look for yourself. I stongly advise you to take the restitutiepolis. https://www.zilverenkruis.nl/-/media/zilverenkruis/files/consumenten/veelgesteldevragen/niet-gecontracteerdezorg/tarievennietgecontracteerde-zorg/tarieven-niet-gecontracteerde-zorg-2021/tarieven-medisch-specialistische-zorg-2021.pdf. I am not from ZK. It seems I cannot send you an attachment. Therefore only 2 lines copied.

    14B182
    Punctie en bevruchting in het laboratorium met eventuele terugplaatsing van embryo('s) bij IVF-behandeling
    € 1.390,85 restitutie
    € 998,51 natura (= ZEKER).
    14B183
    Stimulatie en punctie bij IVF- of ICSI-behandeling
    € 1.553,42 restitutie
    € 1.120,47 natura (=ZEKER)

    I want to inform you that, in the case that you permanently live in Portugal, it perhaps would be perhaps possible to get a S1/S2 form???? 
    I also advise you to get the referral from the Dutch huisarts ( to avoid problems). 

    Possibly there will be other problems with the medicines. ZK tends to not reimbursing them if they are not in the “ preferente list”. Inform yourself on that topic!