Sir, Madam
You have indicated that you would like to be treated in my practice. In agreement by the law on the Medical Treatment Agreement (MTA) we ask you to read this letter carefully before treatment. I will keep a signed copy on file. In case of a quality check this agreement will be shown. Also in case of a difference of opinion about the treatment policy, it could bring a solution to the matter.
This practice has a contract with all health insurances for a “basic exercise therapy rate”. Every health insurance has its own rate. We will send the invoice directly to your health insurance ( VGZ, IZZ, IZA, UMC, UNIVé, ZEKUR, bEWUZ,United Consumers, Aevitae-VGZ, CZ, OHRA, Nationale Nederlanden, Just). you do not have to do anything.
Exceptions are; MENZIS-AnderZorg- and HEMA , Zilverenkruis, AON, IAK-AON, Zorg en Zekerheid, DSW, ONVZ, ASR, ENO, Salland, PMA, ONE; we do not have a contract with them. In that case you may declare the invoice personally at your own health insurance.
Do you have no supplementary health insurance? Then you pay after every visit with Pin-Tikkie- or cash , €44,50 per 30 minutes. Or 60 minutes treatment is €89,00.
The first appointment is always 60 min., of which the intake is 30 min. You will be charged the Basic Exercise rate. The compensation will come out of your supplementary insurance.
Exercise Therapy with children under the age 18 is always a matter of Basic Insurance up to 18 treatments.
If you are unable to come to the practice on the date due, you need to cancel 24 hrs ahead of time at no charge, or change the appointment by phone, person to person (06 496 203 92) or email info@oefentherapieeindhoven.nl
Appointments on Monday need to be cancelled/ altered before Friday 18.00hrs. If you don’t cancel or change, under every circumstance you will be charged the full amount, also in case of superior numbers. In case of neglect, the full treatment fee will be charged being; €44,50 .
I am not responsible for compensations from your health insurance. Every supplementary insurance package has its own maximum compensation. Take in consideration that most insurances add both Exercise and Physiotherapy together.
Signed by;
Name: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Signature: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Place: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Date: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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