The Health Insurance Office (Zorgverzekeringskantoor – ZVK) Sint Eustatius / Saba wants to clarify the steps to be taken when an insured person is referred to a specialist and therefore has to deal with the procedure for medical care abroad.
Reference
The insured person first goes to his practitioner. If the practitioner deems it necessary that the patient receives specialized care, the patient is referred to a specialist. The doctor gives the patient a referral note for the specialist. Furthermore, the doctor sends the medical referral form to the Zorgverzekeringskantoor. In most cases, the agreement for medical care abroad is made by the practitioner with possible support of the ZVK.
Procedure for medical care abroad
For medical care abroad with contracted health providers in St. Maarten, Guadeloupe and Colombia the practitioners do not need to request permission. In the event that an insured person should be referred to a non-contracted healthcare provider, the practitioner does have to request permission.
To obtain this permission, the doctor must complete the so called "consent form" and send it to the ZVK. On this form the physician must explain why the patient needs to go to a non-contracted specialist. This form is received by the employees of the ZVK who will handle the permission request with the utmost discretion. The employee will have the permission request evaluated on medical necessity by the ZVK doctor. The ZVK doctor advises the head of the ZVK based on the medical aspects of the referral for medical care abroad. The head of the ZVK does not review the medical records any more, but only reviews whether the referral is in the insured package.
All parties that have to deal with the permission have a confidentiality obligation and have done the oath or a vow. Once it is decided whether or not the permission is given, the practitioner will be notified. If the permission is given, then referral procedure for medical care abroad is followed.
Medical care abroad
For the referral for medical care abroad the practitioner completes a "referral form for medical care abroad" and sends this form to the ZVK. On this form there will be:
– the name, surname and ID of the patient,
– the specialist to whom the insured person is referred and the authorization number if applicable,
– the date and time of the appointment, so the ZVK ticket and possibly a hotel can be reserved for the insured.
The insured person can collect his/her plane ticket at the Zorgverzekeringskantoor as soon as this is ready.
Forms to take along
The insured shall take the following forms along to the specialist abroad:
– Referral letter from the doctor (this is a letter in which the doctor communicates with the specialist about the diagnosis of the patient, this letter does not come in the possession of the ZVK)
– Warranty Letter As of May 1, 2012 the insured person will only receive a letter of guarantee in case he/she has not been referred to a non-contracted healthcare provider. For referrals to contracted healthcare providers, a warranty is no longer needed.
All patient data is very carefully handled with. In addition, each employee of the ZVK as a civil servant has a confidentiality obligation. If the patient feels that his rights are violated, which also entails that a civil servant has violated the confidentiality obligation, the patient can file a complaint against the respective employee.
The insured shall take the following forms along to the specialist abroad: – from the doctor (this is a letter in which the doctor communicates with the specialist about the diagnosis of the patient, this letter does not come in the possession of the ZVK)- As of May 1, 2012 the insured person will only receive a letter of guarantee in case he/she has not been referred to a non-contracted healthcare provider. For referrals to contracted healthcare providers, a warranty is no longer needed.All patient data is very carefully handled with. In addition, each employee of the ZVK as a civil servant has a confidentiality obligation. If the patient feels that his rights are violated, which also entails that a civil servant has violated the confidentiality obligation, the patient can file a complaint against the respective employee.
For questions and information please contact the ZVK on:
Saba
Tel: 416 3552
Fax: 416 3520
E-mail: InfoSabazvk@rijksdienstcn.com
Opening hours: Monday till Friday 8:00 – 12:00 and from 13:00 – 16.00
Sint Eustatius
Tel: 318 3375/318 4957/318 4954
Fax: 318 3378
By phone: 8:00 -12:00 pm and from 14.00 – 15.00
E-mail: InfoSt.EustatiusZVK@rijksdienstcn.com
Opening hours ZVK office:
8:00 -12:00 pm, in the afternoon by appointment only.