The Health Insurance Office (ZVK) would like to provide clarity about the steps to be taken when an insured person is referred to a specialist and therefore is faced with the procedure of a medical referral.
Referral:
The insured goes first to the general practitioner. When the general practitioner finds that the patient requires specialist care, the patient is referred to the specialist. The general practitioner gives the patient a referral letter for the specialist. The general practitioner of the insured makes the appointment. In the event the specialist is not on Bonaire the insured will be referred to Curacao, Aruba or Colombia.
Procedure during medical referral
Before a medical referral a procedure should be followed. All questions pertaining medical referrals are first evaluated by the indication committee. When an insured is referred by the general practitioner to a specialist outside Bonaire and this specialist does not have a contract with ZVK, then the head of ZVK should grant consent.
In order to obtain permission the general practitioner needs to complete the so-called "consent form" and send this to ZVK. On this form the general practitioner should motivate why the patient must go to a non-contracted specialist. This form goes to the medical assistant of the ZVK and who handles the request for permission with all discretion. The worker will have the request form evaluated by the indication committee on the medical necessity. The indication committee comprises 3 doctors. They advise the head on the basis of the medical aspects of the referral. This no longer checks the medical data, but only if the referral is included in the package of the insured. All parties who deal with the consent have the obligation of secrecy. The moment it is decided whether or not the permission will be granted the general practitioner will receive a message about this. In the event the permission is granted the procedure for medical referral follows.
Medical referral
For medical referrals the general practitioner completes a "request medical referral form" and forwards this form to the ZVK. On this form will be listed:
· Name, sir name and ID of the patient
· The specialist when the insured is referred and the permission number if applicable
· The date and time of the appointment, so that the ZVK can book a ticket and possibly a hotel for the insured
· The banking details of the insured ,so that ZVK can deposit the daily allowance
The insured can, upon presentation of passport, collect their ticket three days in advance at the travel agency or the airline.
Take along forms:
The insured takes the following forms along to the specialist outside Bonaire:
Referral letter from the general practitioner (this is a letter wherein the general practitioner communicates with the specialist about the diagnosis of the patient, this letter does not come into the hands of the ZVK),
Guarantee letter (in this it exclusively stated that the ZVK stands guarantee for the medical costs of the insured, with this letter the specialist can invoice the ZVK).
All patient data is treated with extreme care. Besides each ZVK worker as civil servant have an obligation of secrecy. In the event the patient feels his rights were violated, which also include that a civil servant has violated the obligation of secrecy, the patient can then file a complaint against the concerned worker.
For all questions you can contact the ZVK on +715-8899. You can also email to in*****@ri***********.com