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Cheap health insurance carries large risks29 November 2013, by Alexandra Gowling
Dutch health insurance policies with the lowest premiums carry serious financial risks, according to research done by RTL News. If you go to a hospital that is not one of a list approved by your policy, you may be liable for up to half of the cost of the operation.
CZ, Coöperatie VGZ, Achmea and Menzis insurance companies have all made their budget policy agreements with a limited number of hospitals in the Netherlands.
Only in those hospitals will patients be fully reimbursed for their treatment; at a different hospital, patients may be out of pocket for anything between 20 and 50 per cent of the total amount.
What policies don’t cover
This extra cost applies only in the case of elective ("plan-able") surgery in hospitals not listed in the policy. What the policies consider elective includes relatively minor procedures such as a tonsillectomy, but can include the treatment of some cancers.
For example, with a CZ ZorgBewust policy, you may only go to contracted providers for the treatment of bladder cancer, breast cancer, cleft palate and stomach surgeries, among others. If you go to a non-contracted provider, you will have to pay half the costs yourself.
CZ responded by saying that this is because they do not want people going to hospitals that do not provide sufficiently good quality for these conditions, because they do not perform these sort of operations often, for example. It has nothing to do with the price of the policies, they claimed.
For Menzis Budget Bewust policy, you have to pay 40 per cent of the cost if you are treated at a non-contract hospital for conditions including breast and prostate cancer.
For Zilveren Kruis Beter Af Selectief you are only covered at one of 23 selected hospitals, otherwise you must pay 30 per cent; while Univé Zekur has a list of 16 hospitals, otherwise it’s a 20 per cent extra cost.
No warning from doctor or hospital
RTL News also reported that neither general practitioners nor hospitals are warning patients that they may not be fully covered by their insurance.
The National Association of General Practitioners said that, "We refer patients on the basis of medical necessity. Cost considerations play no role in referral. What is reimbursed and what is not part of the agreement is between the patient and insurer. The GP is not part of that."
Patient Federation NPCF said they were shocked by the discovery. They said that hospitals should warn patients if they are not fully ensured.
They also said health insurers must take more care that their customers are better informed about the consequences of taking out the cheapest insurance policies.