Zorg & Zekerheid

Dear midwife,

It will have escaped no one's attention: Zorg & Zekerheid is retroactively clawing back paid contraception consultations from 2025.

We are receiving questions from multiple practices: what should we do with this?

🙋‍♀️ A fair question that we answer in the Louwco Practice Growth Letter.

(Read the full message from Zorg & Zekerheid at the bottom of this email.)

It is incomprehensible that a health insurer determines whether or not midwives get paid for the care they provide—especially when clients rate this care so positively.

Research even shows that 58.2% of respondents give contraceptive care by midwives a top rating of 10 out of 10, with the median score also being a 10.

“Clients felt taken seriously, received understandable information, and had sufficient time during the appointment. The interviews especially highlighted appreciation for the way midwives put them at ease, their expertise, and good accessibility.” — read the full study here

At the same time, general practitioner (GP) care is under severe pressure, dealing with patient intake stops and capacity issues.

Why then contract contraceptive consultations with GPs and not with midwives?

Unfortunately, only Zorg & Zekerheid itself can answer that question.

In any case, we find it a terrible waste and a missed opportunity for low-barrier, accessible, and expert women's healthcare in the Netherlands.

How can you limit the damage?

Assess the scope

It is possible to generate a report of the consultations reimbursed in 2025 by Zorg & Zekerheid, specifically performance codes 1717 and 1718 (pre- and contraception consultations). This will show you how many claims and what total amount are involved.

Would you like this report for your practice? Reply to this email or contact mail@louwco.nl.

Verify the clawback

If applicable, you will soon receive invoices for the care Zorg & Zekerheid is reclaiming. These invoices will specify which claims are concerned. Check these in your own system and verify if the reclamation is correct.

If you have a billing subscription with Louwco, we are naturally happy to do this for you if you wish. Reply to this email or contact mail@louwco.nl.

Determine your approach

It is up to you to decide whether to absorb these costs yourself or pass them on to the client. If you consider the latter, wait for a response from Zorg & Zekerheid first. It is possible they have already recovered the delivered care from clients via their deductible (eigen risico). If you charge the clients, they might end up paying twice. We have contacted Zorg & Zekerheid asking for clarification on this point.

Inform your clients

Establish agreements within your practice on how to communicate about this. For example, some practices mention on their website that contraception care for clients insured with Zorg & Zekerheid may be (partially) at their own expense. You can also choose to ask beforehand where someone is insured when booking an appointment and inform them about potential costs if relevant.

It is, in any case, an unpleasant and unwanted situation for both practices and clients.

Do you have questions following this news or this Practice Growth Letter?

Reply to this email or mail to mail@louwco.nl.

We are happy to think along with you.

Message from Zorg & Zekerheid:

“An audit of the claims submitted by your practice revealed that Zorg & Zekerheid reimbursed claims for performance codes 1717 and/or 1718 (preconception and contraception consultations) over the period from January 1, 2025, to present.

We hereby inform you that, in accordance with Zorg & Zekerheid's applicable procurement policy and the healthcare agreement concluded between Zorg & Zekerheid and your practice, these services are not contracted for midwives. For that reason, these services should not have been claimed with Zorg & Zekerheid.

The claims concerned were nevertheless processed and paid out. As a result, these payments should not have occurred in retrospect. Zorg & Zekerheid will therefore correct these claims and recover the unduly paid amounts.

The relevant claims will be adjusted. You will receive a written request for reimbursement of the unduly paid amounts, along with a specification of the claims and further processing of the correction.

We have since updated our billing systems so that claims for performance codes 1717 and 1718 will no longer qualify for reimbursement in accordance with applicable policy and contractual agreements. New claims for these performance codes will therefore no longer be paid.

We realize that correcting previously paid claims can be frustrating and may raise questions. We consider it important to emphasize that this is a rectification of payments that should not have occurred under current contractual agreements and procurement policies. As a health insurer, we are required to correct such erroneous payments.

If you have questions regarding this letter or believe certain claims were incorrectly included in the adjustment, please contact us at zorginkoop.geboortezorg@zorgenzekerheid.nl. We are happy to discuss this with you.”