Medical billing
Netherlands — NZa tariffs, the eigen risico and the SKGZ dispute route
NationalNLDerived or secondary source
Netherlands
- Rule id
- medical.nl
- Version
- 1.0.0
- In force from
- January 1, 2006
- Last read against its sources
- August 5, 2026
- Countries bound
- Netherlands
In plain language
What this regime says.
Dutch providers may only charge tariffs established by the health authority. Insured people pay a statutory own risk each year before the insurer contributes, and disputes with insurers go to a free, binding dispute committee.
Who is covered
People insured under the Zorgverzekeringswet and treated in the Netherlands.
What you get
A regulated tariff, correct application of the own risk, and an independent binding decision against an insurer.
Where claims go wrong
- Not realising that a treatment episode spanning a year end can consume two years of own risk.
- Paying without checking the declaratiecode against the published tariff.
Authority
Every citation,
with its pinpoint.
A claim that cites “EU law” gets filed. A claim that cites Article 7(1)(c) gets answered. These are the exact coordinates this entry rests on.
- Wet marktordening gezondheidszorg (Wmg), art. 35Wet marktordening gezondheidszorgURL verified 2026-08-05art. 35 — it is prohibited to charge or to pay a tariff that has not been established by the Nederlandse Zorgautoriteit, or that differs from one that has been
- ZorgverzekeringswetZorgverzekeringswetURL verified 2026-08-05The compulsory basic insurance, the covered basket, and the statutory own risk (eigen risico)
Sources
Where a figure is indexed, converted or published by a regulator rather than fixed in the instrument, the provenance is recorded separately. Anything marked as a modelled estimate is exactly that — a model, not a statutory number.
- Disputes with a health insurer — Stichting Klachten en Geschillen ZorgverzekeringenSKGZretrieved 2026-08-05
What it imposes
Clocks, defences and the ladder.
A rule module builds these while it evaluates, because a limitation period depends on which forum is open to you. What follows is the structure this regime produces — deliberately with no dates and no figures, because those belong to your facts rather than to the law.
What it entitles you to, beyond money
- A tariff established by the NZa, and no otherArticle 35 Wmg. Ask for the declaratiecode and check it against the published tariff.
- An independent decision on a dispute with your insurerThe SKGZ operates a free ombudsman and a binding dispute committee for disputes between insured people and health insurers.
Where to take it next
- Ask the provider for the declaratiecode and the tariffCheck it against the NZa tariff for that code before paying anything.Claim directtypically 21 days
- Complain to your health insurerInsurers must operate an internal complaints procedure before the SKGZ will take a case.Internal appealtypically 30 days
- SKGZ — Ombudsman Zorgverzekeringen and the GeschillencommissieBinding on themFree, independent, and the committee's decision binds the insurer.Ombudsmantypically 120 daysofficial page
- Nederlandse ZorgautoriteitTakes reports of tariffs charged outside the regulated structure under article 35 Wmg.Regulatortypically 90 days
Documents
What this regime can produce.
Every one of these is a document you send yourself, in your own name. Duesday never writes to anybody on your behalf and is never anyone’s agent.
The same claim type elsewhere
EU cross-border healthcare — Directive 2011/24/EU reimbursement, the EHIC and the S2EUSupranational — 27 countriesDirective 2011/24/EU, Arts. 6, 7 and 8Confidence: highFrance — dépassements d'honoraires, secteur 1 and 2, and the OPTAMFRNational — FranceCode de la santé publique, art. R. 4127-53Confidence: mediumGermany — the GOÄ and GOZ private billing schedules and their multiplier limitsDENational — GermanyGebührenordnung für Ärzte (GOÄ), §§ 2, 5 and 12Confidence: mediumIreland — public hospital charges, medical cards and the HSE complaints routeIENational — IrelandHealth Act 1970 (as amended)Confidence: lowItaly — Servizio Sanitario Nazionale, the ticket and the URP routeITNational — ItalyLegge 23 dicembre 1978, n. 833Confidence: lowSpain — Sistema Nacional de Salud coverage and the right to economic informationESNational — SpainLey 41/2002, de autonomía del pacienteConfidence: lowUnited Kingdom — NHS charging, overseas visitor invoices and private healthcareGBNational — United KingdomNational Health Service Act 2006, s. 1(4)Confidence: mediumArizona surprise out-of-network bill dispute resolution (A.R.S. § 20-3111 et seq.)US-AZSub-national — United StatesA.R.S. § 20-3111 et seq.Confidence: medium
Other rights in the same countries
European Union — delivery rights on consumer sales (Directive 2011/83/EU, Art. 18)EUSupranational — 30 countriesDirective 2011/83/EU, Art. 18Confidence: mediumEuropean Union — price indication, drip pricing, pre-ticked extras and surchargingEUSupranational — 27 countriesDirective 98/6/EC, arts. 2(a) and 3(1)Confidence: highEuropean Union — rail passenger rights (Regulation (EU) 2021/782)EUSupranational — 30 countriesRegulation (EU) 2021/782, Art. 19Confidence: highEuropean Union — Representative Actions Directive (EU) 2020/1828EUSupranational — 27 countriesDirective (EU) 2020/1828 on representative actions for the protection of the collective interests of consumersConfidence: highEU cross-border healthcare — Directive 2011/24/EU reimbursement, the EHIC and the S2EUSupranational — 27 countriesDirective 2011/24/EU, Arts. 6, 7 and 8Confidence: highEU air carrier liability for baggage (Regulation (EC) No 2027/97)EUSupranational — 31 countriesRegulation (EC) No 2027/97, Art. 1 (as amended by Regulation (EC) No 889/2002)Confidence: highEU ePrivacy Directive and GDPR (direct marketing)EUSupranational — 30 countriesDirective 2002/58/EC (ePrivacy Directive), Art. 13Confidence: mediumEU General Data Protection RegulationEUSupranational — 30 countriesRegulation (EU) 2016/679, Arts. 15–21Confidence: high
Does this one reach your facts?
The engine runs every regime that could apply at once and reconciles them, rather than making you guess which page to read.
Not a law firm. Not legal advice. You send it yourself. This page describes a law; it is not advice about your situation and no outcome is promised.