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Old 10.04.2015, 18:36
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Which insurance model suites me with chronic situation?

Deal All,

I am new to switzerland and have been searching for the forum for a couple of day about the insurance. To a person like to many options only mean confusion but not flexibility. Now I am stuck by the insurance model so I come here for your help.

I have a pre-condition, and I need to visit a specialist every 3 months, take ultrasound, and get prescription. I know GP model is cheaper, but I don't know if the referal could generate some extra charge that is not covered by the basic insurance and turns out to be the same as premium of a standard model. I also saw a lot recommendation about Sanacare, it is not far from me, but I don't know the HMO suites me either....I tried to consult the sales person of an insurance company, but we even struggled by some simple question because she could not understand my English

I remember there is some disucssion about this topic but unfortunately I did not save it and could not find it anymore. So please be kindly share your wisdom, experience and give me your suggestions.

Thanks in advance and have a nice weekend.
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Old 10.04.2015, 20:08
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Re: Which insurance model suites me with chronic situion?

Sanacare will send you to the specialist , very flexible I went to an eye Dr in a different canton which was my choice.
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Old 10.04.2015, 21:19
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Re: Which insurance model suites me with chronic situion?

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Sanacare will send you to the specialist , very flexible I went to an eye Dr in a different canton which was my choice.
Thank you for the first answer! By Sanacare do you mean Sanicare? Which model do you use? GP? Standard? Or else?
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Old 10.04.2015, 21:51
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Re: Which insurance model suites me with chronic situation?

Sanacare is a heath center company in Switzerland, closely associated with Visana.

http://www.sanacare.ch/htm/home.htm

I have a Visana HMO policy with Sanacare doctors, and I am very happy with both.
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Old 10.04.2015, 22:51
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Re: Which insurance model suites me with chronic situation?

Hi

I think it's important that you can speak, understand and be understood when it comes to dealing with health insurance company reps. Make sure you are going for a company that leaves no doubts they offer service in all 4 languages (German, French, Italian and English), leave no room for misunderstandings.

Here is my opinion about Telemed:
From my experience, the option to be able to go to specialist without seeing a GP for a referral is very convenient. I canít imagine going to a GP for each single referral. Instead, my plan allows me just to call the insurer, and they will advise me which doctors I can book with, typically they will transfer your call directly to the practice and you can make appointment or they will drop you an email with specialists in your area which you can contact when it suits you. They will also ask you if you have already found a preferred consultant, then they just confirm they recorded your call and you have a green light to go ahead and book your appointment (given that the clinic/practice is covered by this insurer).

Now, being in your position this is what I would do:
Assume you select HMO or GP model, calculate how many times you will need to see the GP or HMO for referral per month (theoretically) and how long will each consultation take. Find online typical hourly rate of GP/HMO. From that take the 10% excess and add this to the total you pay in quoted premium per month.

Then compare your results with what you would pay for Telemed.

I am generally not keen on dealing with GP as this is additional ring in the chain. It takes time and time is important. Although, as you have a chronic condition and are new to Switzerland, perhaps a personal and regular contact with someone like a GP could help you maintain a good health track record. If this is important to you, and you would not rather have to face the decision of whom to see for consultation, I think HMO/GP model will be better working for you. However if you like to take things in your own hands then Telemed is more practical.
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Old 11.04.2015, 00:41
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Re: Which insurance model suites me with chronic situion?

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Sanacare will send you to the specialist , very flexible I went to an eye Dr in a different canton which was my choice.
Yes that may be true, but they will only send most patients to the specialist on their lists. They have vested commercial interests in managing health care and employ the doctors in their HMO clinics to do just that, to steer the majority of patients only to other HMO approved doctors.

Do yourself a favor and don't lock yourself into an HMO model. I have a very difficult to treat chronic condition and I can tell you from my experience here in Switzerland you need to be able to get to the best specialists when needed. Take a look at EGK and the models they offer, they may be more expensive up front but I can tell you from experience it is worth it in the long run.
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Old 11.04.2015, 20:40
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Re: Which insurance model suites me with chronic situation?

I've been treated for cancer with many follow ups. We've used the telemedicine model and have been very happy with our access to and choice of providers, even going out of Kanton for care with basic. We use viva care - the telemedicine people speak English - not all the service reps do, but you'll usually find one that does.
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Old 12.04.2015, 01:00
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Re: Which insurance model suites me with chronic situion?

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Yes that may be true, but they will only send most patients to the specialist on their lists. They have vested commercial interests in managing health care and employ the doctors in their HMO clinics to do just that, to steer the majority of patients only to other HMO approved doctors.

Do yourself a favor and don't lock yourself into an HMO model. I have a very difficult to treat chronic condition and I can tell you from my experience here in Switzerland you need to be able to get to the best specialists when needed. Take a look at EGK and the models they offer, they may be more expensive up front but I can tell you from experience it is worth it in the long run.
The Dr has no commercial interest to send you anywhere, if you have a preference they will let you go to any specialist. They don't have any specialists in house so it's a non issue
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Old 12.04.2015, 01:45
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Re: Which insurance model suites me with chronic situion?

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The Dr has no commercial interest to send you anywhere, if you have a preference they will let you go to any specialist. They don't have any specialists in house so it's a non issue
Isn't the problem with HMOs that your allocated GP can only send you to a specialist who is on their in-house list of approved/affiliated people?
Lists which I understand can be very restrictive and almost certainly won't include the top dog in whichever field you think you need.

Personally I prefer the option of being able to go directly to any expert I need to see, without needing to go via my GP... although mine is a delight and I'm sometimes tempted to book an appointment just because I fancy a quick chat!
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Old 12.04.2015, 08:31
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Re: Which insurance model suites me with chronic situion?

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Isn't the problem with HMOs that your allocated GP can only send you to a specialist who is on their in-house list of approved/affiliated people?
Lists which I understand can be very restrictive and almost certainly won't include the top dog in whichever field you think you need.

Personally I prefer the option of being able to go directly to any expert I need to see, without needing to go via my GP... although mine is a delight and I'm sometimes tempted to book an appointment just because I fancy a quick chat!
No, not in my experience, I changed insurer & wanted to go to the Same eye Dr in another canton, not an issue. Oh I just went & told them about it after , carried on for the next 5 years.... Not an issue, many people look for problems that don actually exist. The guy was the head of the hospital.......
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Old 12.04.2015, 10:53
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Re: Which insurance model suites me with chronic situation?

I am a health care professional and spend a great deal of my time telling patients to go to a general practitioner, NOT a specialist. Neither the GP nor I have a vested interest, but the patient often thinks they know which specialist they need. They frequently dont. However the GP will send to the correct specialist using exam-based and experience-based criteria. He/she also keeps a general dossier and has an overall view, whereas a specialist only looks for what he is asked to pertaining to his specialty.

Some complaints may need several specialists, but they need to be seen in the correct order. Also, simple complaints (conjunctivitis, tonsillitis, twisted ankle, childrens illnesses...) can be treated quickly, efficiently and more cheaply by the GP. These economies are passed on to us as they affect the price of our premiums.

A GP will usually send his patients to specialists that he knows and respects. There are no referral 'deals' between doctors. Those at the top of their field charge the same for a consultation as all others (Tarmed). Waiting lists to see a specialist can be up to 3 months, but a GP can get an urgent appointment easily for his patients, because he can validate the urgency, and because the specialist is a colleague.

Last edited by Marsalforn; 12.04.2015 at 11:05.
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Old 12.04.2015, 17:34
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Re: Which insurance model suites me with chronic situation?

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I am a health care professional and spend a great deal of my time telling patients to go to a general practitioner, NOT a specialist. Neither the GP nor I have a vested interest, but the patient often thinks they know which specialist they need. They frequently dont. However the GP will send to the correct specialist using exam-based and experience-based criteria. He/she also keeps a general dossier and has an overall view, whereas a specialist only looks for what he is asked to pertaining to his specialty.

Some complaints may need several specialists, but they need to be seen in the correct order. Also, simple complaints (conjunctivitis, tonsillitis, twisted ankle, childrens illnesses...) can be treated quickly, efficiently and more cheaply by the GP. These economies are passed on to us as they affect the price of our premiums.

A GP will usually send his patients to specialists that he knows and respects. There are no referral 'deals' between doctors. Those at the top of their field charge the same for a consultation as all others (Tarmed). Waiting lists to see a specialist can be up to 3 months, but a GP can get an urgent appointment easily for his patients, because he can validate the urgency, and because the specialist is a colleague.
Yes, this is quite true. Many physicians here require a referral from a GP - it's not an insurance requirement, more a practice requirement. However, in the case where you have an existing chronic condition, I think the OP was wondering if he (or she) has to go to the GP before going to the specialist every time.

Once you've established a relationship with the specialist, it makes sense in some cases to follow up with the specialist. I would not, for example, have my oncology follow up with my GP, but rather my gyn and oncologist - those docs communicate with the GP and I deal with other issues with the GP.

It depends on the issue, of course, but if imaging and special screening is involved, it could be more efficient to see a specialist.
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Old 12.04.2015, 17:46
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Re: Which insurance model suites me with chronic situation?

When we changed insurers a couple of years back, on the paper work my husband accidentally checked off the HMO option, this is how I ended up being sent to a Sanacare through KPT. I told them I l already had a GP in my village but they still wanted me to go to their HMO group practice in the neighboring Canton. This was a huge inconvenience for me and since I already had a GP who was overseeing my specialist referrals, I was really surprised that they refused to let me keep my already well established GP and specialists who had a good overview of my history. Nevertheless they insisted. I went for one appointment at Sanacare and was told that I would only be referred to the specialists on their approved list. Since I have a very difficult to treat chronic painful condition I asked the insurer to change us back to the GP model we had been on under with our previous insurance company so I could continue my treatments as usual.

That was my experience and I'm happy to be back on a insurance plan where I can select my own doctor under a GP model and without the interference of a insurance controlled and limited specialist list.

Correct me if I'm wrong but I think Sanacare Group practices are owned by an insurance company.

Last edited by Swissish; 12.04.2015 at 19:14.
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Old 12.04.2015, 17:52
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Re: Which insurance model suites me with chronic situation?

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Correct me if I'm wrong but I think Sanacare Group practices are owned by an insurance company.
Correct, however Dr's don't get told how to treat their patients, or to prescribe cheap drugs, My Sanacare Dr Suggested trying Crestor statin which she felt was a wonder drug, cost 15 times that of a cheap statin, she was thinking of taking it herself even though her cholesterol was fine........
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Old 12.04.2015, 17:59
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Re: Which insurance model suites me with chronic situation?

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Yes, this is quite true. Many physicians here require a referral from a GP - it's not an insurance requirement, more a practice requirement. However, in the case where you have an existing chronic condition, I think the OP was wondering if he (or she) has to go to the GP before going to the specialist every time.

Once you've established a relationship with the specialist, it makes sense in some cases to follow up with the specialist. I would not, for example, have my oncology follow up with my GP, but rather my gyn and oncologist - those docs communicate with the GP and I deal with other issues with the GP.

It depends on the issue, of course, but if imaging and special screening is involved, it could be more efficient to see a specialist.
I agree with you entirely. Normally after the first visit the specialist will inform the GP how he intends to manage the case, if this is necessary, then the patient continues to see the specialist.
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Old 12.04.2015, 18:02
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Re: Which insurance model suites me with chronic situation?

Not sure how true this is for CH- if a group practice is owned by an insurance company, I'd be very impressed if they do not have incentives for sending them to their own group.

Certainly in the UK, particularly recently with the rise in private health care- the BMJ and other official bodies have exposed some very unholy and very concerning alliances, massive incentives, financial and otherwise- between Consultants, privat clinics/hospitals and private insurances. If a Consultant (Senior specialist) gets free consulting rooms in a private clinic, and access to the equipment there, including MRI, x-ray and blood testing services, and often supporting staff too, etc- there are 'good' (eg bad) reasons for this. The BMJ and other official bodies are asking for those to become transparent and the info available to patients.

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Old 12.04.2015, 18:52
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Re: Which insurance model suites me with chronic situation?

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Correct, however Dr's don't get told how to treat their patients, or to prescribe cheap drugs, My Sanacare Dr Suggested trying Crestor statin which she felt was a wonder drug, cost 15 times that of a cheap statin, she was thinking of taking it herself even though her cholesterol was fine........
Sounds like you had a good experience with your doctor there. Good to hear, although the debate regarding the use of a statin is somewhat controversial. Despite that a prescription for a patented medication vs. the generic is quite a different issue.
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Old 12.04.2015, 19:28
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Re: Which insurance model suites me with chronic situation?

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.
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Old 12.04.2015, 22:43
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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.
I agree mostly with what you've said but I would qualify that further. Diabetes is a fairly common chronic condition these days and it seems based on your statement that you have it well under control, good for you. Not all chronic diseases are so easily managed. The OP stated he/she needs an ultrasound every 3 months plus already prescribed medications. I wouldn't want to guess what this is for. Nor would I want to make any assumptions or statements that would lead anyone new here to believe they would get the best care possible in Switzerland by shaving a few francs off the monthly premiums without knowing more about the precondition.

I think we've given the OP some good information on which to make a decision. It would be interesting to hear back about what he/she ultimately chooses and how it all works out as in the end hopefully we'll all be better educated about how the insurance system works here especially for preexisting conditions.

Btw...I have a really brilliant GP who specializes in practicing integrative medicine and he does so much more for me than just delivering a simple flu jab.

Last edited by Swissish; 12.04.2015 at 23:04.
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Old 12.04.2015, 23:01
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Re: Which insurance model suites me with chronic situation?

Wow, a big thank you to all above, Joga-trn, Swissish, edot, fatmanfilms, Angela, fatmanfilms, Marsalforn, Odile, catandmouse (I hope I did not miss anyone) you shared your experience and gave me your pratical suggestions. Perhpas I am too new in the forum and could not Thank the thread you made, so I write it here.

What you said did answer my concerns of GP and HMO model- the limited list of the specialist and may not access best ones when necessary. I have been treasted for over 3 years back in my country before I came here, and the treatment was blood test and ultrasound to make sure everything in under control or even make some better progress, and got the perscription from the specialist. I suppose I should do the same here. So GP is not necessary for such follow ups except for the first time referral.

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?
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