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Old 15.04.2015, 09:17
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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'm sorry if I was confusing. Mikers gave a good summary above.



We went with Telmed originally to save money and because I'd had experience of telephone triage centers in the US. Moving to Switzerland without prior experience, and no doctors, we figured that the Telmed system would work well for us if we had a hard time finding good primary care. As it turned out, we found a GP and I've not used Telmed for referrals, just for reporting and a few instances of urgent care.



I believe that everyone needs to have some access to primary care. And my specialists won't handle my every day stuff, so I have to have a GP. I really like my GP - I can walk to her office, she knows her stuff, so I like dealing with her. But Telmed is the least expensive model (so I've been told).



Anyway, I've not had any new illnesses for a while, so when I need an appointment, I call Telmed and say I'm seeing doctor X for condition Y and they usually give me 3 appointments within a 3 month period. Then I see the doctor. But I call Telmed once I've scheduled anything. It's really not hard to do.



A few years ago, I saw three orthopedists for opinions on my knee. I made an appointment with my GP, we talked about possible doctors (I found some, she had a recommendation) and she wrote to the three docs. I made appointments with the three docs (it was pretty quick after she wrote the letters). I called Telmed about my appointment with my GP and then for the three Orthopods. No problems having the opinions paid for, and I chose one of the surgeons to replace my knee in the future.



When I had active treatment for cancer, I called Telmed the beginning of the year and told them I'd be having chemo and rads in this facility and I didn't have to call again till the next calendar year.



For a new problem, you can also call Telmed and they'll have you talk to a doctor. You're under no obligation to follow the advice, however, and you can always see your own physician. I've heard differing opinions about the quality of the advice given.



My husband had some puzzling allergic reactions a few years ago, once going to emergency, and inconclusive results on the allergy tests. He called Telmed from the US when he had another reaction and he found them very helpful in suggesting how to take his meds, what to look for and reassuring him.



So I hope that helps a bit. We probably use Telmed more for the cost savings than the referral part.
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Last edited by edot; 15.04.2015 at 10:46.
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  #42  
Old 18.04.2015, 10:23
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Re: Which insurance model suites me with chronic situation?

This has been an interesting discussion - and has made me wonder if switching insurance models might be beneficial.

My main concern is access to care.

I have traditional basic insurance, that is I may in theory see any doctor I wish, hospitalization excepted.

However, as few specialists will see a patient without a GP recommendation (and few GPs are willing to take on new patients, so finding a GP in order to get that referral is difficult) the reality is that access is limited even with this model. So I wonder if paying the extra for the traditional model is worth it.

Those with an HMO type model - does the network help you to gain access? That is, once signed up with the network does the local GP have to take you on, or did you face the same scramble to find a GP open to new patients? What sort of waiting times to see specialists within the network have you experienced?

And those with Telmed - is there an assessment of the urgency of a case to help in reducing the waiting time for an appointment?

Your insights would be appreciated.

As above, I wonder if I would be better off with another insurance model. (Or at least no worse off, but with a bit more money left in my pocket.)

Many thanks.
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Old 18.04.2015, 11:22
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Re: Which insurance model suites me with chronic situation?

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This has been an interesting discussion - and has made me wonder if switching insurance models might be beneficial.

My main concern is access to care.

I have traditional basic insurance, that is I may in theory see any doctor I wish, hospitalization excepted.

However, as few specialists will see a patient without a GP recommendation (and few GPs are willing to take on new patients, so finding a GP in order to get that referral is difficult) the reality is that access is limited even with this model. So I wonder if paying the extra for the traditional model is worth it.

Those with an HMO type model - does the network help you to gain access? That is, once signed up with the network does the local GP have to take you on, or did you face the same scramble to find a GP open to new patients? What sort of waiting times to see specialists within the network have you experienced?

And those with Telmed - is there an assessment of the urgency of a case to help in reducing the waiting time for an appointment?

Your insights would be appreciated.

As above, I wonder if I would be better off with another insurance model. (Or at least no worse off, but with a bit more money left in my pocket.)

Many thanks.
The HMO is a brilliant concept. The first time you make an appointment you get assigned one of the Dr's, in the 2 MHO practices I used the first Dr I saw was very good, 1 is the best Dr I ever had. You can actually see any Dr in the practice for example if your Dr is away (or you did not like them).
What I liked the most is having a blood test 15 minutes before the appointment & the Dr having the results 15 minutes later.
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