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  #21  
Old 12.04.2015, 23:22
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Re: Which insurance model suites me with chronic situation?

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But from your above disscussion, I found that both Telmed and standard seemed both have the freedom to see the specialist. What's the difference then?
Monthly premiums for telmed are lowe than standard. the telmed model does require you to call into the callcenter when you have an illness. For pre existing stuff, t's usually to inform them of a new appointment. If you have a complex history, they usually tell you to see your doctor anyway.

The other vaiable is your franchise - lower franchise, higher monthly cost. If you expect a lot of costs, e.g., scans, orescriptions, lower franchise might be best to start.
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  #22  
Old 12.04.2015, 23:42
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Re: Which insurance model suites me with chronic situation?

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I have a chronic condition, diabetes, and visit a specialist about three times a year. I don't want to waste time seeing a GP on top of that when all he will do is to send me back to my diabetologist and bill me 100 CHFs for the pleasure. Do yourself a favour, get the basic model and don't waste time with HMOs and family doctors. Those models are OK if you need occasional flue jabs, but not for chronic issues.
If diabetes is well controlled, there is absolutely no need to visit a diabetologist regularly. Your GP can run the full range of blood tests 2 or 3 times a year, mainly HbA1C- and if there are no changes in your long-term blood sugar, that is it, no need to see the diabetologist. It is a real injustice to GPs and their training to say they are only safe to administer the 'occasional flu jab'- honestly.

I am always surprised how so many parents here take their children to a pediatrician for very simple common ailments which a GP is perfectly able to deal with, like coughs and colds- a total waste a specialist time and insurance money too.
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  #23  
Old 12.04.2015, 23:55
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Re: Which insurance model suites me with chronic situation?

Thank you edot, I am now almost for the Telmed option. I will talk to the insurance people face to face to discuss some more details and hopefully I can get the insurance done this week.

And yes you are right, I set the franchise to 300CHF, since I found even the medicine I am taking is expensive here.
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Old 13.04.2015, 09:39
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Re: Which insurance model suites me with chronic situation?

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Thank you edot, I am now almost for the Telmed option. I will talk to the insurance people face to face to discuss some more details and hopefully I can get the insurance done this week.

And yes you are right, I set the franchise to 300CHF, since I found even the medicine I am taking is expensive here.
I read in the paper that it is quite difficult to find a GP on the Zurich area these days. Sounds like the telmed option is a good option for you plus when it comes time to have a physical checkup they should be able to refer you to someone accepting new patients.

Regarding the medications be sure to check if there are any generics available. If the medication is off-patent and a generic is available you have to pay a higher co-pay% instead of the usual 10% the co-pay is increased between 15% or 20% depending on the medication. I was told that if I need to have the branded medication it has to be specifically prescribed by my doctor stating no generic substitution.

Good luck with everything here and welcome to the forum.
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Old 13.04.2015, 10:18
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Which insurance model suites me with chronic situation?

We found a GP in Winterthur quite easily. It's a group practice within Winti med. I believe they might be part of a larger group within Switzerland - medix. Our GP in Bern was part of this group. No association with specific insurers as far as I can tell. They have literature about the GP model but don't push it and are ok working outside their network.

Are you quite sure about the medication copays? I am pretty sure I'm paying a flat 10% on all my meds, regardless of generic or not. But I'll check.

Last edited by edot; 13.04.2015 at 10:32.
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Old 13.04.2015, 10:49
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Re: Which insurance model suites me with chronic situation?

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We found a GP in Winterthur quite easily. It's a group practice within Winti med. I believe they might be part of a larger group within Switzerland - medix. Our GP in Bern was part of this group. No association with specific insurers as far as I can tell. They have literature about the GP model but don't push it and are ok working outside their network.

Are you quite sure about the medication copays? I am pretty sure I'm paying a flat 10% on all my meds, regardless of generic or not. But I'll check.
Yes, I'm quite certain this is correct about the co-pays on medication because I just last week questioned my insurer and then verified it with my pharmacist. The pharmacist confirmed that it's not just my insurer it's the way rules work across the board. Perhaps it's just that my insurer is holding us to the letter of the law while other insures may be more lenient.
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Old 13.04.2015, 11:03
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Re: Which insurance model suites me with chronic situation?

Here is the reply from KPT regarding one of my medicines.

MEDI OPK 20% ARZT (KVG) 52,30 : Hierbei handelt es sich um das Medikament XXXX. Seit dem 1. Januar 2006 gilt bei den Medikamenten ein differenzierter Selbstbehalt. Die damals in Kraft getretene Regelung besagte, dass bei Originalpräparaten ein Selbstbehalt von 20% erhoben werden muss, wenn in der SL Generika aufgeführt waren, deren Höchstpreise mindestens 20% unter demjenigen des Originalpräparates liegen. Als Ausnahmen gelten Medikamente die aus medizinischen Gründen nicht substituiert werden können. Allerdings muss das auch so vom Arzt auf der Verordnung/Rezept vermerkt werden.

Google translation

MEDI OPK 20% DOCTOR (KVG) 52.30: This is the drug XXXX. Since 1 January 2006, a differentiated deductible for the drugs. That entered into force regime said that in original preparations an excess of 20% will be charged if the SL generics were listed, the maximum prices at least 20% below that of the original product. Exceptions apply the medication can not be substituted for medical reasons. However, it must also be noted that the physician to prescribe / recipe.
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  #28  
Old 13.04.2015, 11:04
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Re: Which insurance model suites me with chronic situation?

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Regarding the medications be sure to check if there are any generics available. If the medication is off-patent and a generic is available you have to pay a higher co-pay% instead of the usual 10% the co-pay is increased between 15% or 20% depending on the medication. I was told that if I need to have the branded medication it has to be specifically prescribed by my doctor stating no generic substitution.
Thansk for the reminding. I just checked with the company if they have my med on their list, but did not know the copay!
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Old 13.04.2015, 11:15
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Re: Which insurance model suites me with chronic situation?

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Thansk for the reminding. I just checked with the company if they have my med on their list, but did not know the copay!
There is more information on this thread ...

Deductible / Excess / Franchise - which is the best one to choose?
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  #30  
Old 13.04.2015, 13:32
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Re: Which insurance model suites me with chronic situation?

Huh. I believe you! I just looked at all my meds and only 2 are non generic and apparently not substituted out. So that must be why I pay 10%.

I've only been here since 2007, so the rule was in force when I arrived.

Thanks, had no idea.
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Old 13.04.2015, 15:16
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Re: Which insurance model suites me with chronic situation?

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If diabetes is well controlled, there is absolutely no need to visit a diabetologist regularly. Your GP can run the full range of blood tests 2 or 3 times a year, mainly HbA1C- and if there are no changes in your long-term blood sugar, that is it, no need to see the diabetologist. It is a real injustice to GPs and their training to say they are only safe to administer the 'occasional flu jab'- honestly.
Don't agree with this, speaking from my own experience with my GP, she was at a total loss with diabetes, trying to treat me like "painting with numbers". If your numbers are this, then do that. She managed to treat me for type 2 diabetes (and failed) for 2 years when I actually have type 1 diabetes (unusual at my age, but it does happen). My GP had no understanding whatsoever of the condition.
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Old 13.04.2015, 15:23
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Re: Which insurance model suites me with chronic situation?

Ah absolutely- you need to see a specialist at the onset of the disease, for proper diagnosis and treatment- but then, once the disease is under control with the proper advice and treatment from the specialist- there is no need to see the specialist every time, unless the blood results show change- or maybe once a year (which is why my comment said 'if your diabetes is well controlled...)

Last edited by Odile; 13.04.2015 at 19:38.
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Old 13.04.2015, 18:34
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Re: Which insurance model suites me with chronic situation?

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There is more information on this thread ...

Deductible / Excess / Franchise - which is the best one to choose?
This is really good one, thanks!
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  #34  
Old 13.04.2015, 20:16
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Re: Which insurance model suites me with chronic situation?

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Don't agree with this, speaking from my own experience with my GP, she was at a total loss with diabetes, trying to treat me like "painting with numbers". If your numbers are this, then do that. She managed to treat me for type 2 diabetes (and failed) for 2 years when I actually have type 1 diabetes (unusual at my age, but it does happen). My GP had no understanding whatsoever of the condition.
Right, type 1 is a totally different animal, and it is often missed in adults. I have a friend diagnosed in her 50's. But also because type 1 always requires insulin, it requires close monitoring, I suspect you are better off with an endocrine specialist or a GP with a special interest in diabetes.

It's really important that your specialists and your GP play nice with each other too. I really liked my GP in Bern, and my oncologist, but they had a bit of a pissing match at one point, and I had the impression my GP didn't like my oncologist. I think it was an ego thing. Since I was leaving Bern anyway, and they behaved like grownups, it was ok. But I suspect that had we stayed in Bern, I'd have found another GP.

So when I found my new GP in Winti, I asked her if she'd have an issue working with my docs (gyn and onc) in Bern, and she has been totally cool.

I mention this just because if you're dealing with specialists, you need to make sure that they will work with your GP, and that your GP will work with them. I think if you're using a specialist not recommended by your GP, you need to discuss the visit with your GP and make sure information is flowing in both directions. And when you're feeling unwell, that's not always easy to do.

Is a diabetologist the same thing as an endocrinologist? Is that a UK thing?
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Old 13.04.2015, 21:07
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Re: Which insurance model suites me with chronic situation?

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I mention this just because if you're dealing with specialists, you need to make sure that they will work with your GP, and that your GP will work with them. I think if you're using a specialist not recommended by your GP, you need to discuss the visit with your GP and make sure information is flowing in both directions. And when you're feeling unwell, that's not always easy to do.m
This is so true. At the moment I have two specialists, one therapist, and one GP. They all communicate when necessary, which means that I get the best possible care.
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Old 14.04.2015, 10:08
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Re: Which insurance model suites me with chronic situation?

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Right, type 1 is a totally different animal, and it is often missed in adults. I have a friend diagnosed in her 50's. But also because type 1 always requires insulin, it requires close monitoring, I suspect you are better off with an endocrine specialist or a GP with a special interest in diabetes.

It's really important that your specialists and your GP play nice with each other too. I really liked my GP in Bern, and my oncologist, but they had a bit of a pissing match at one point, and I had the impression my GP didn't like my oncologist. I think it was an ego thing. Since I was leaving Bern anyway, and they behaved like grownups, it was ok. But I suspect that had we stayed in Bern, I'd have found another GP.

So when I found my new GP in Winti, I asked her if she'd have an issue working with my docs (gyn and onc) in Bern, and she has been totally cool.

I mention this just because if you're dealing with specialists, you need to make sure that they will work with your GP, and that your GP will work with them. I think if you're using a specialist not recommended by your GP, you need to discuss the visit with your GP and make sure information is flowing in both directions. And when you're feeling unwell, that's not always easy to do.

Is a diabetologist the same thing as an endocrinologist? Is that a UK thing?
And I suspect that's what happened in my case. The GP and my diabetologist didn't understand each other. As I'm never ill, I basically never consult a GP anyway, so my diabetologist looks after the rest of me too.
And yes, a diabetologist is the same as an endocrinologist - guess it's an example of UK vs US English.
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Old 14.04.2015, 10:36
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Re: Which insurance model suites me with chronic situation?

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And yes, a diabetologist is the same as an endocrinologist - guess it's an example of UK vs US English.
I think diabetologist must be a relatively new term as I'm from the UK and had never heard the term until Odile mentioned in a previous thread.
Diabetes specialists were called endocrinologists when I was younger and my father had regular appointments to see them due to his diabetes. Maybe some endocrinologists choose to specialise solely in diabetes ( as there are so many diabetics now) and don't routinely treat other endocrine problems nowadays hence the name change.
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Old 14.04.2015, 11:33
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Re: Which insurance model suites me with chronic situation?

That makes sense. I remember hearing that while lots of endocrine specialists deal with diabetes, it's a lot more difficult to find, for example, someone with an interest in thyroid.
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Old 14.04.2015, 23:30
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Re: Which insurance model suites me with chronic situation?

Thank you very one, today I just talked to Helsana and decided to sign the contract with Telmed model tomorrow. I feel comfortable because they sent a sales person speaking English explained a lot open questions, and more importantly they provided English contract, saving a lot effort for me using google tranlsation and guessing.

edot, I am a little confused when the you talking about GP with Telmed model. How does it work if you have to call first whenver you need to see a doctor be it a special list or other ones? Thanks!
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Old 15.04.2015, 07:18
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Re: Which insurance model suites me with chronic situation?

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Thank you very one, today I just talked to Helsana and decided to sign the contract with Telmed model tomorrow. I feel comfortable because they sent a sales person speaking English explained a lot open questions, and more importantly they provided English contract, saving a lot effort for me using google tranlsation and guessing.

edot, I am a little confused when the you talking about GP with Telmed model. How does it work if you have to call first whenver you need to see a doctor be it a special list or other ones? Thanks!
I use Telemed with helsana. You call the number and let themkmow of any upcoming visits. The idea is if it's something they can help you with over the phone they will but anyway you have to cal them the first time you go for any new condition or topic.

Despite how it may sound it's simple quick and easy. It's not some sort of grilling it's just an admin record really. If you're healthy and it's something new they might be able to help I don't know but for me I just book appointments with specialists directly, call Telemed and tell them I've done it because I know my own condition and they say ok lovely keep on seeing him then and give is a ring if you still are see my them in more than 3 months. It's dead easy and totally non threatening.
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