Choose your own care provider: What do you need to know?
According to article 10 paragraph 4 of the Healthcare Insurance Decree BES you can personally choose a care provider, however ZJCN does not have an agreement with every care provider. Do you want to receive care from a care provider without an agreement? Then you first need to ask ZJCN for consent.
How does it work?
If you want to go to a different care provider than the one referred to you by your general practitioner or specialist, you must submit a request. This must be done prior to the treatment. Requests cannot be handled afterwards.
Approval or rejection
ZJCN can approve or reject the request. If there are enough other care providers available with an agreement and of good quality then ZJCN may reject your application. Hence, make sure you have consent before starting the treatment.
Payment and reimbursement
You advance the costs yourself. After that, you send the invoice to ZJCN. ZJCN checks the invoice and reimburses a part of or the full amount. ZJCN does not pay the care provider directly.
What is required for a request?
- A referral letter from the general practitioner or specialist.
- An offer from the care provider with a description of the treatment and the costs.
- A declaration of agreement signed by you.
Please note: An incomplete request is not being processed.
Legal rules
The rules are laid down in the Health Insurance Decree BES. In principle, you must go to a care provider that has an agreement with ZJCN. You can only visit a care provider without an agreement with prior consent.
The comprehensive regulations governing the freedom to choose a care provider are laid down in article 4 paragraph 10 of the Health Insurance BES Act.