Most of the routine, but also the specialized determinations in clinical biology are so-called reimbursed by the statutory health insurance (mutuality). For this purpose, certain rules must be complied with, which are determined per test by the National Institute for Health and Disability Insurance (NIHDI). These rules are applied by laboratories when drawing up your invoice.
In order to be able to apply the reimbursement rules correctly, your physician need to mention your mutuality details on the application form, for example by means of a mutuality device.
In addition to the traditional reimbursement, some people are entitled to increased interference by the mutuality. The so-called W.I.G.W.-statute. This statute can be granted to:
- Widows, widowers, invalids, pensioners and orphans and their dependants.
- Children who have the right to increased child benefits.
- People entitled to the subsistence level or to the guaranteed income for elderly people and their dependants.
You have to apply for the W.I.G.W.-statute or the preference scheme at your health insurance.
Third-Party Payment Scheme
In our country, there is a so-called ‘third-party payment scheme’. This ensures that you only pay ‘your share’ of the costs directly to the lab and that the share for the health insurance is settled directly with the lab by the mutuality.
Structure of an invoice
An invoice for services in clinical biology is drawn up through rules laid down in a Royal Decree and consists of three parts:
- Reimbursed services: services that are reimbursed according to the NIHDI rules are fully or partially borne by the mutuality; the patient pays nothing or only the reimbursed share.
- Non-reimbursable services: services that are not reimbursed according to the NIHDI regulations are charged to the patient.
- Agreed fee: is determined on the basis of the number and type of the NIHDI reimbursable provisions carried out; both the mutuality and the patient pay a share in this. There is no share for the patient with the smallest applications.
- Supplementary fees; are never charged for:
- Patients benefiting from a W.I.G.W.-statute or a preferential treatment
- Applications for which the cumulated b-value is lower than B700
- Analyses with b-value > 1000
- Pathological anatomy
- Most molecular tests
- The tests related to the COVID-19 pandemic
In the limited cases where they are charged, the amount charged will never exceed € 8.7.
The details of the structure of our invoices can always be found on the document attached to the invoice sent to you.
For questions or remarks, you can always contact our invoicing department on 03/30 30 830 or via email@example.com.
Each invoice is considered final by the client unless the client submits a reasoned protest by registered letter within 21 days of the invoice date. Invoices are payable within 30 days of the invoice date. In addition to the reminder fee of € 5 (first reminder) and € 8 (second reminder) after expiry of the payment term, in the event of non-payment your file will be transferred to a specialized third party authorized to exercise the activity of amicable recovery. This is mandated for the collection of the amounts owed increased with late payment interest of 1% per month and with a fixed compensation of 15%, but at least € 25, without prejudice to the right to prove the actual damage suffered if this is greater.
The value attributed to each determination on an invoice is calculated based on the so-called b-value determined by the National Institute for Health and Disability Insurance (NIHDI).
Whether the cost price of this analysis is borne by the mutuality or the patient, and thus reimbursed or not, is regulated by different types of NIHDI rules:
Diagnostic rules: the test will only be reimbursed if the condition states in the diagnostic rule is met. The conditions apply to:
- Competence for performance
- Competence of the applicant: tests are sometimes only reimbursed if the applicant can present a certain specialisation
- Characteristics of the analysis carried out: e.g., method
- Characteristics of the patient: certain disorder, age category, etc.
- Whether an analysis has been reimbursed in the past (maximum of times per year or years)
Cumulation rules: the test will NOT be reimbursed if it occurs together with a certain other test on one and the same application.
Maximum rules: a test will be reimbursed a maximum number of times per sample collection.
Consult our 'Information brochure' for an overview of the main cumulative and diagnostic rules or consult the website of the NIHDI.