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Old 24.01.2015, 20:21
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Visana not reimbursing initial pregnancy check up costs.

Hi All,

I have Visana basic insurance with Zusatzversicherung/Basic supplementary health check up. Although Visana now seems to be not in favor of reimbursing what is written in the documents I got from them. For example:

1. In Oct 2014, I went to my gyn for a preventive gynecological checkup (for the first time). For the same I got the bill of around 400 chf from my gynecologist. Visana denied straight forward to reimburse the same.

--In the documents it's written: Preventive gynecological examinations = 90% (300 chf max.) once in 3 years.

--I went to visana and asked them why is it not covered, as it's the first time only, they replied that the supplementary insurance can be availed only after 3 years. That means I have to first pay for 3 years the cost of supplementary insurance and then afterwards I can get these kinds of costs reimbursed (not covered in basic).

--However in the documents they provided it's not written anywhere about this "special" hidden condition.

2. After this I got pregnant in december and went to the hospital for my first checkup. This time I got the bill of 550chf + 55chf (prenatal tablets bill). Again Visana has asked us to pay the bills.

I contacted all my friends living in Switzerland and to my surprise even Asura reimbursed the bill starting from their first visit.

Since now it's weekend I have to wait again till Monday to clear things out with Visana, but I was wondering if anyone of you know the expected reply from Visana.

I am really disappointed as we have been paying premium almost what we used to pay in Swica and Visana is just not reimbursing any of the medical bills till now.
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Old 24.01.2015, 20:57
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Re: Visana not reimbursing initial pregnancy check up costs.

From comparis:

8. Medical prevention

Basic health insurance covers the cost of certain examinations for early detection of diseases as well as the cost of preventative measures for policyholders who are at a higher risk for certain diseases. These examinations or preventive measures must be performed or prescribed by a doctor. They are:
Up to 8 examinations of state of health and normal development for children at pre-school age
Screening for phenylketonuria, galactosaemia, biotinidase deficiency, adrenogenital syndrome, hypothyreosis and vitamin K prophylaxis
HIV tests for infants of HIV-positive women
HIV tests for persons at higher risk of contracting HIV
Gynaecological examinations (the second examination after one year, after that one examination every 3 years)



5. Additional benefits in case of maternity

Examinations performed by doctors or midwives and examinations ordered by doctors during and after pregnancy. Mandatory basic health insurance covers the cost of 7 routine examinations (2 of which may be ultrasound scans, between the 10th and 12th as well as between the 20th and 23rd week of pregnancy, more in case of a high-risk pregnancy) and a post-natal examination (6 to 10 weeks after giving birth).
Childbirth either at home, in a general hospital ward in the canton of residence or in a semi-inpatient situation, including preparation and aid provided by doctors or midwives.
Up to three breastfeeding consultations
Important: Maternity benefits are neither subject to the deductible nor to the coinsurance. On 1 March 2014, a legal amendment initiated by the Federal Council took effect. It stipulates that women who fall ill during or after pregnancy (e.g. in case of complications) are no longer liable to any out-of-pocket payments starting from the 13th week of pregnancy until 8 weeks after birth. This encompasses, for example, hospitalisation to avoid premature birth, treatment of gestational diabetes and infections or psychotherapy due to post-natal depression.
Tip: Women who wish to be able to choose their gynaecologist freely for giving birth either at the hospital or at home will need private or semi-private supplemental insurance, which must be purchased early enough.


Source

Are you pregnant at present? If you're not, not every gynaecological test is covered. If you are pregnant and believe your appointments should be paid for, the ombudsman for health insurance will be the place you'll want to contact next to ask for specific advice.
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Old 24.01.2015, 21:04
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Re: Visana not reimbursing initial pregnancy check up costs.

400chf for a smear test??? My bill is around 50chf from the Dr and 20chf from the lab!!
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Old 24.01.2015, 21:09
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Re: Visana not reimbursing initial pregnancy check up costs.

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400chf for a smear test??? My bill is around 50chf from the Dr and 20chf from the lab!!
If you're planning to try for a baby, the standard pre-TTC checkup here includes a transvaginal ultrasound and I forget what all else. Definitely not just a smear.

Mind you, I'm only guessing from the timeline, but it sounds as though this may have been the situation - which would explain the cost.
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Old 24.01.2015, 21:16
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Re: Visana not reimbursing initial pregnancy check up costs.

So just to clarify the info from glowjupiter...

The exam OP had in October is not covered because it was the first gyn exam and they only cover from the second?

The exam OP had in December is not covered because she was not yet at the 10th week of pregnancy?

Or she needs to pay her franchise first? Or...?

I'm confused.

Last edited by 3Wishes; 24.01.2015 at 21:17. Reason: was, not is
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Old 24.01.2015, 21:19
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Yes in Oct. it was just a yearly checkup including blood, urine and breast examination. And it costed around 400chf. My concern is not that, as it's already paid long back. But why this first visit bills are not covered that's not clear. It was my 7th week of pregnancy and they did not cover anything including prenatal tablets cost.

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So just to clarify the info from glowjupiter...

The exam OP had in October is not covered because it was the first gyn exam and they only cover from the second?

The exam OP had in December is not covered because she was not yet at the 10th week of pregnancy?

Or she needs to pay her franchise first? Or...?

I'm confused.
Exactly.. I am also confused

Last edited by 3Wishes; 24.01.2015 at 21:28. Reason: merging successive posts
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Old 24.01.2015, 21:31
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Re: Visana not reimbursing initial pregnancy check up costs.

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Yes in Oct. it was just a yearly checkup including blood, urine and breast examination. And it costed around 400chf. My concern is not that, as it's already paid long back. But why this first visit bills are not covered that's not clear. It was my 7th week of pregnancy and they did not cover anything including prenatal tablets cost.

Exactly.. I am also confused
In the 7th week of your pregnancy, ultrasounds are not covered if you're not high-risk, if you are they might be (see my post further up stating comparis). Was an ultrasound done at that appointment and is your pregnancy high-risk?
For further info, ombudsman would help you clarify the situation. From what I understand on the site, the ombudsman services are free.
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Old 24.01.2015, 21:35
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Re: Visana not reimbursing initial pregnancy check up costs.

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Yes in Oct. it was just a yearly checkup including blood, urine and breast examination. And it costed around 400chf. My concern is not that, as it's already paid long back. But why this first visit bills are not covered that's not clear. It was my 7th week of pregnancy and they did not cover anything including prenatal tablets cost.
Note: all the following info is for basic insurance only. Supplementary insurance won't cover you at all for a pregnancy that occurs within X months (varies by insurer, should be somewhere in the fine print) after the start of your policy.

Prenatal vitamins, e.g. elevit, aren't covered by basic insurance.

Normal prenatal checkups are, but you may have to specifically tell them (and your gynae may have to confirm) that the bill is pregnancy-related. The fact you went to a hospital for the checkup rather than to your normal gynae may or may not be complicating things here as well.

Complications (anything from iron tablets or extra ultrasounds up to and including miscarriage) are covered in full after the 13th week of pregnancy, covered as illness (i.e. they're covered to 90%, but only after you've paid the first 300/500/.../2500 CHF yourself) before that.
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Old 27.01.2015, 11:19
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Re: Visana not reimbursing initial pregnancy check up costs.

So I went to Visana yesterday and following are the answers I got for my questions:

1. My preventive gynecological examination was not paid as it is not yet 3 years since I am enrolled with Visana. So I have to wait another 1 year in order to get preventive gynecological examination paid by Visana.

2. I had already informed Visana about changing my gynecologist and they already knew that the next time I will be going to the Frauenklinik in hospital and in any case they said that Gynecologist and Dentist you can change anytime. That's not a problem. For Hausartzt you have to inform.

3. My recent bill (check up at 7th week of pregnancy) was not paid by Visana, because they were not informed about my pregnancy and on the bill it was written as Krankheit rather than Schwangerschaft, so now they will correct it. However they did not say if they will pay it completely or I will have to pay it from my Franchise (waiting again).

With my expereince following are the things I learnt:

1. Do inform your Insurance company about your pregnancy as soon as possible (I did not inform them and that led to a confusion).

2. If you are planning to have a baby in next 1 or 2 years better not to change the Insurance. Because Visana said that luckily we corssed 2 years otherwise the supplementary services of preganacy was not available to us. For eg: In hospital's Mutterschaft book it's written that there will be 3 Ultrasounds. One each trimester. However in Basic cost of only 2 are covered. Supplmentary will cover 90% cost of further checkups or Ultrasounds but only when you are atleast since last 2 years with them.

3. Ask your Insurance company about these "special" condtions in terms of years. For example:

1). Supplementary services related to pregnancy can only be availed after 2 years.

2). Supplementary services related to preventive checkups can only be availed after 3 years.

3). Supplimentary services related to Fitness(Gym) and Optician (only glasses not lenses) can be availed from 1st year.

This was my overall experience and learning.
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Old 27.01.2015, 11:27
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Re: Visana not reimbursing initial pregnancy check up costs.

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So I went to Visana yesterday and following are the answers I got for my questions:

1. My preventive gynecological examination was not paid as it is not yet 3 years since I am enrolled with Visana. So I have to wait another 1 year in order to get preventive gynecological examination paid by Visana.

2. I had already informed Visana about changing my gynecologist and they already knew that the next time I will be going to the Frauenklinik in hospital and in any case they said that Gynecologist and Dentist you can change anytime. That's not a problem. For Hausartzt you have to inform.

3. My recent bill (check up at 7th week of pregnancy) was not paid by Visana, because they were not informed about my pregnancy and on the bill it was written as Krankheit rather than Schwangerschaft, so now they will correct it. However they did not say if they will pay it completely or I will have to pay it from my Franchise (waiting again).

With my expereince following are the things I learnt:

1. Do inform your Insurance company about your pregnancy as soon as possible (I did not inform them and that led to a confusion).

2. If you are planning to have a baby in next 1 or 2 years better not to change the Insurance. Because Visana said that luckily we corssed 2 years otherwise the supplementary services of preganacy was not available to us. For eg: In hospital's Mutterschaft book it's written that there will be 3 Ultrasounds. One each trimester. However in Basic cost of only 2 are covered. Supplmentary will cover 90% cost of further checkups or Ultrasounds but only when you are atleast since last 2 years with them.

3. Ask your Insurance company about these "special" condtions in terms of years. For example:

1). Supplementary services related to pregnancy can only be availed after 2 years.

2). Supplementary services related to preventive checkups can only be availed after 3 years.

3). Supplimentary services related to Fitness(Gym) and Optician (only glasses not lenses) can be availed from 1st year.

This was my overall experience and learning.
When the wife was preggers we had visana and they gave a sheet of stickers to place on each invoice and you'd indicate if it's pregnancy, accident, or just basic on the sticker
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Old 27.01.2015, 11:52
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Re: Visana not reimbursing initial pregnancy check up costs.

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When the wife was preggers we had visana and they gave a sheet of stickers to place on each invoice and you'd indicate if it's pregnancy, accident, or just basic on the sticker
Ours (EGK) did that too, but only once they knew we were pregnant in the first place! So it wouldn't have helped for the first checkup.

(As it happened, we never used any of the stickers - my gynae billed them directly and so did the hospital.)
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Old 27.01.2015, 11:56
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Re: Visana not reimbursing initial pregnancy check up costs.

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When the wife was preggers we had visana and they gave a sheet of stickers to place on each invoice and you'd indicate if it's pregnancy, accident, or just basic on the sticker
The kids are with Visana and they have the same stickers.

And my gynae always write sickness or pregnancy clearly on each bill, which I usually underline in red to be sure it's not missed at the billing service.
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Old 27.01.2015, 12:14
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Re: Visana not reimbursing initial pregnancy check up costs.

Yes we got those stickers from Visana a few months ago. And yesterday they told me the same, that it's very important to stick those with 'Mutterschaft' marked. So as to avoid any confusion.
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Old 27.01.2015, 12:25
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Re: Visana not reimbursing initial pregnancy check up costs.

When my wife was pregnant gyne gave a letter mentioning that she is pregnant, expected due date etc. and asked us to sent it to insurance company(Assura). After that Assura acknowledged the same along with insurance proposal for yet to be born child. They paid for everything except Elevit multivitamins and Magnesium supplement. They also paid for compression stockings. My wife had only basic insurance.

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So I went to Visana yesterday and following are the answers I got for my questions:

1. My preventive gynecological examination was not paid as it is not yet 3 years since I am enrolled with Visana. So I have to wait another 1 year in order to get preventive gynecological examination paid by Visana.

2. I had already informed Visana about changing my gynecologist and they already knew that the next time I will be going to the Frauenklinik in hospital and in any case they said that Gynecologist and Dentist you can change anytime. That's not a problem. For Hausartzt you have to inform.

3. My recent bill (check up at 7th week of pregnancy) was not paid by Visana, because they were not informed about my pregnancy and on the bill it was written as Krankheit rather than Schwangerschaft, so now they will correct it. However they did not say if they will pay it completely or I will have to pay it from my Franchise (waiting again).

With my expereince following are the things I learnt:

1. Do inform your Insurance company about your pregnancy as soon as possible (I did not inform them and that led to a confusion).

2. If you are planning to have a baby in next 1 or 2 years better not to change the Insurance. Because Visana said that luckily we corssed 2 years otherwise the supplementary services of preganacy was not available to us. For eg: In hospital's Mutterschaft book it's written that there will be 3 Ultrasounds. One each trimester. However in Basic cost of only 2 are covered. Supplmentary will cover 90% cost of further checkups or Ultrasounds but only when you are atleast since last 2 years with them.

3. Ask your Insurance company about these "special" condtions in terms of years. For example:

1). Supplementary services related to pregnancy can only be availed after 2 years.

2). Supplementary services related to preventive checkups can only be availed after 3 years.

3). Supplimentary services related to Fitness(Gym) and Optician (only glasses not lenses) can be availed from 1st year.

This was my overall experience and learning.
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Old 27.01.2015, 15:01
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Re: Visana not reimbursing initial pregnancy check up costs.

SWICA also pays from day one of insurance under additional insurances, you won't have to wait for 3 years (what a long time of not getting pregnant, like you plan to wait 3 years)
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Old 27.01.2015, 15:35
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Re: Visana not reimbursing initial pregnancy check up costs.

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So I went to Visana yesterday and following are the answers I got for my questions:

1. My preventive gynecological examination was not paid as it is not yet 3 years since I am enrolled with Visana. So I have to wait another 1 year in order to get preventive gynecological examination paid by Visana.

2. I had already informed Visana about changing my gynecologist and they already knew that the next time I will be going to the Frauenklinik in hospital and in any case they said that Gynecologist and Dentist you can change anytime. That's not a problem. For Hausartzt you have to inform.

3. My recent bill (check up at 7th week of pregnancy) was not paid by Visana, because they were not informed about my pregnancy and on the bill it was written as Krankheit rather than Schwangerschaft, so now they will correct it. However they did not say if they will pay it completely or I will have to pay it from my Franchise (waiting again).

With my expereince following are the things I learnt:

1. Do inform your Insurance company about your pregnancy as soon as possible (I did not inform them and that led to a confusion).

2. If you are planning to have a baby in next 1 or 2 years better not to change the Insurance. Because Visana said that luckily we corssed 2 years otherwise the supplementary services of preganacy was not available to us. For eg: In hospital's Mutterschaft book it's written that there will be 3 Ultrasounds. One each trimester. However in Basic cost of only 2 are covered. Supplmentary will cover 90% cost of further checkups or Ultrasounds but only when you are atleast since last 2 years with them.

3. Ask your Insurance company about these "special" condtions in terms of years. For example:

1). Supplementary services related to pregnancy can only be availed after 2 years.

2). Supplementary services related to preventive checkups can only be availed after 3 years.

3). Supplimentary services related to Fitness(Gym) and Optician (only glasses not lenses) can be availed from 1st year.

This was my overall experience and learning.
That (time of entry into insurance) should not be relevant (if Visana doesn't put preventive examinations into supplementary insurance), but the duration between this preventive gynaecological examination and the last one (see bolded line in my comparis post).
So, if you had your last preventive examination three years ago, no matter who your insurer was, IMO they should cover. If you had the last checkup e.g. 2.5 years ago, no matter what your insurance was, they shouldn't.
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Old 27.01.2015, 15:46
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Re: Visana not reimbursing initial pregnancy check up costs.

Interestingly, I have a Gyne/Smear test yearly… and my insurance always pays, and trust me they don't pay anything they don't have to. However, my Gyne is also my Hausarzt so I wonder if this makes a difference to them having to pay her bills?
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Old 27.01.2015, 15:54
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Re: Visana not reimbursing initial pregnancy check up costs.

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Interestingly, I have a Gyne/Smear test yearly… and my insurance always pays, and trust me they don't pay anything they don't have to. However, my Gyne is also my Hausarzt so I wonder if this makes a difference to them having to pay her bills?
I have a yearly smear test too, and my insurance always pays too. And I go to a gyn, not my GP.
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Old 27.01.2015, 15:54
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Re: Visana not reimbursing initial pregnancy check up costs.

I'm always confused by these threads. When you say "doesn't pay" do you mean no coverage at all or do you mean subject to franchise/deductible.

I've seen a gyn yearly since arriving in 2007 and my yearly gyn exam is covered subject to my franchise. Of course I'm way too old to have a child.

I do understand that pregnancy comes out of a different pot.
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