We are often asked if we could break down the invoice by specifying the cost per visit, or if we could indicate which individual treatments make up the total of the invoice.

To be clear, you usually ask us this question because you are asked to do so by your insurance company. Without such information, the respective insurance company would not be able to reimburse the costs.

In almost all cases, these are health insurances that do not normally bill in the Dutch system and are therefore not familiar with the local billing of clinics and medical practices (usually so-called ZBCs). Dutch insurances, but also most insurances of international organisations, are familiar with the way of invoicing that is common here.

In all other cases, insurance companies are willing to accept your invoice if you send them a doctor's letter with the respective diagnosis. You will receive such a doctor's letter from us on request.

The Dutch billing system DBC/DOT

In order to give the answer promised at the beginning, we have to dive a little deeper into the subject-matter and point out some peculiarities of the Dutch health care system. Although the Statenkliniek does not bill the Dutch health insurance companies directly [1], we are still bound by the rules of the local authority, the NZa (Nationale Zorgautoriteit, https://www.nza.nl). In practice, this means that we, the Statenkliniek, are billing on the basis of the Dutch DBC/DOT system [2].

Being bound by the rules of the local authority means that we bill on the basis of a DBC. Within a DBC, the visit to the Statenkliniek, the consultation by the doctor, the making of the diagnosis, the histology and laboratory costs, the treatment and possible control visits are included, without this being itemised separately. Therefore, we can only give the costs as a lump sum per DBC.

When the treatment is completed, the invoice is issued. The DBC is registered in a special online system ("Grouper") and checked for compliance with the rules. After successful verification, the bill is electronically signed by the Grouper and cannot be changed afterwards. As a patient, you can recognise the successful verification by the so-called hash code (a kind of checksum) [3], which is shown at the end of the invoice [4].

How many treatments?

A DBC is completed when either no further treatment is needed or a certain time frame set by NZa is exceeded. As the number of visits within a DBC ("zorgtraject") depends on the individual situation, we cannot state in advance what the cost per visit will be. Here are two examples: You come to the dermatologist to have a mole (nevus) examined. The dermatologist examines you and finds that the nevus is absolutely benign and no cause for concern. No further visits to the doctor are necessary and the DBC can be closed [5]. On the other side of the spectrum, a second example: The dermatologist diagnoses you with psoriasis, which involves extensive light treatment with several weekly visits. The "zorgtraject" is then closed and invoiced after recovery or after a period of time determined by the NZa.

Therefore, for the reasons mentioned above, it may well be that the same amount is billed for a treatment that includes two visits, for example, as for a single visit.

Can I get an invoice immediately after the treatment?

In some cases, you as a patient may want to be billed immediately after the visit. This is of course possible, but only if you have indicated that you are insured with a health insurance company that is not affiliated to the Dutch system. Typically, these are the health insurances from your home country or international organisations, or you have registered with us as a patient paying for yourself [6]. Otherwise, we are only able to invoice you once the relevant period has expired.

I have submitted my paid invoice to the health insurance company, but they want a proof of payment for the invoice. Can Statenkliniek help me?

We can gladly confirm payment of your bill by mail. Another possibility is for you to send a screenshot or similar of the transfer from your online banking app to your insurance company. Unfortunately, we cannot send you a statement of our bank account.

The level of our fees

As far as the amount billed is concerned, NZa sets the structure of the services, but not the costs themselves. We determine these at the beginning of the year and publish them at https://statenkliniek.nl/en/costs/passtar/). In doing so, we use the average values of other health care facilities as a reference. It may therefore be that other health care institutions charge higher amounts in some cases and lower amounts in others than the Statenkliniek.

We hope that we have been able to explain the Statenkliniek's billing system to you. Should you need further explanations, do not hesitate to contact our front desk or to use one of the ways described here: https://statenkliniek.nl/en/contact/.



¹ As a patient, you always pay your bill directly to us. You are then free to submit the invoice to your health insurance company for reimbursement.
² A DBC, Diagnosis Treatment Combination, is the total care process from the diagnosis to the treatment (if any) and its declaration. DOT, DBCs on the road to transparency, is the process to improve the declaration system for hospitals that has been in place since January 2012.
³ A typical hashcode would look like this: PLJ1Macd5NndiWz/.../4KphHm/bMys=
⁴ Ultimately, the system recognises how many visits, which treatment and which diagnosis the patient is charged for by means of various identifiers ("diagnose", "prestatiecode" and "zorgproductcode").
⁵ You may decide to have the nevus removed at the Statenkliniek for aesthetic reasons. However, if the diagnosis is benign, this would be a medical cosmetic service, which we will charge you for separately. These services are usually not reimbursable by the health insurance.
⁶ In these cases, you do not need a referral letter from your general practitioner.