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Old 13.11.2015, 13:08
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Important questions about health insurance?

Hi All,

I have a policy with Assura for last one year with the highest deductible (2500 CHF) with PharMed. I didn't have to use my insurance at all last year, but the coming year I am sure I would need to use it.

That's why I am planning to switch to a standard model (free choice of doctors) + a low deductible of 300 franks. However, before I do that I have a few important questions:

1. What does it mean exactly to have "free choice of doctors" ? Does this mean that I can get second opinions and third opinions from different doctors if I am not satisfied with the previous doctor ?

2. My back and shoulder has been hurting for a while as I have been working quite hard recently (sitting too much on computer). Does free choice mean that I can go to osteopaths and chiropractics at will ? Does it also mean that I can consult a psychologist if I want to ?

3. On comparis it says that "However, the amount reimbursed by the insurer varies according to valid tariffs for your place of residence or work." on this page: https://en.comparis.ch/krankenkassen...sicherung.aspx .

Does anybody know what it means ?

If anyone can answer them, I will be really grateful.

thanks,
Amit


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Old 13.11.2015, 13:12
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Re: Important questions about health insurance?

I doubt your insurance will pay for second or third opinions, you will almost certainly have to pay for that.

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Hi All,

I have a policy with Assura for last one year with the highest deductible (2500 CHF) with PharMed. I didn't have to use my insurance at all last year, but the coming year I am sure I would need to use it.

That's why I am planning to switch to a standard model (free choice of doctors) + a low deductible of 300 franks. However, before I do that I have a few important questions:

1. What does it mean exactly to have "free choice of doctors" ? Does this mean that I can get second opinions and third opinions from different doctors if I am not satisfied with the previous doctor ?

2. My back and shoulder has been hurting for a while as I have been working quite hard recently (sitting too much on computer). Does free choice mean that I can go to osteopaths and chiropractics at will ? Does it also mean that I can consult a psychologist if I want to ?

3. On comparis it says that "However, the amount reimbursed by the insurer varies according to valid tariffs for your place of residence or work." on this page: https://en.comparis.ch/krankenkassen...sicherung.aspx .

Does anybody know what it means ?

If anyone can answer them, I will be really grateful.

thanks,
Amit


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Old 13.11.2015, 13:16
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Re: Important questions about health insurance?

If you go to one doctor for an appointment and then go to a different doctor for another appointment (even about the same thing), there is no real reason why the Krankenkasse will/should not pay for that. There is no reason for the health insurance to even link the two separate appointments. You should be able to do this if you have a 'free choice of doctors'.
I have a Hausarztmodell, yet I still have appointments with other doctors, all of which have to be paid for by the Krankenkasse (and indeed they are). You only pay your initial excess, then 10% of the actual costs thereafter, up to a maximum of Fr.700.-- per annum.
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Old 13.11.2015, 18:03
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Re: Important questions about health insurance?

1. Free choice of doctors: You are not restricted to using doctors affiliated with your insurer. You are not restricted to going to one family doctor/GP. You can go directly to specialists without being forwarded by a GP. You can do all of this at any time. And you may consult others, although I am not sure whether it covers getting opinions from different doctors.

2. You will have to read the fine print on your insurance to figure out what is covered. Some are covered if prescribed by a doctor. One other option is to take an affordable supplementary insurance that might give you more flexibility.

3. Afaik, whatever is reimbursed is the total sum minus the (deductible + 10% of all bills).
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Old 13.11.2015, 18:15
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Re: Important questions about health insurance?

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whatever is reimbursed is the total sum minus the (deductible + 10% of all bills).
Excluding the cost of transportation by ambulance (only covered up to a certain amount per annum) and hospital stays (Fr.15.-- per day currently I believe is the charge).
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Old 13.11.2015, 18:19
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Re: Important questions about health insurance?

Most chiropractors are covered under the basic (KVG) insurance (been there). Psychologists are also covered under KVG, provided that they are working with a psychiatrist who delegates his duties - this is standard practice in ZH. Means that you can't quite freely choose who see if you want them to pay for it.
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Old 13.11.2015, 18:31
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Re: Important questions about health insurance?

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Does this mean that I can get second opinions and third opinions from different doctors if I am not satisfied with the previous doctor ?.
One other thing: ask your critically-orientated friends/colleagues (or even EF!) to recommend doctors that they trust. When you are unwell, it would be wiser to get a quick and correct opinion that jumping around seeking opinions. Note that it may take a while to finally see a doctor (especially specialists). Another option is to ask the first doctor if he/she could forward you to another doctor (one of my friends did this).

As for the "the amount reimbursed by the insurer varies according to valid tariffs for your place of residence or work", the answer is in the following sentence:
Quote:
If you undergo treatment outside these areas, you will have to brace yourself for uncovered costs.
https://en.comparis.ch/krankenkassen...sicherung.aspx

Last edited by vuachère; 13.11.2015 at 18:42. Reason: italics
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Old 13.11.2015, 18:36
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Re: Important questions about health insurance?

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Another option is to ask the first doctor if he/she could forward you to another doctor (one of my friends did this).
You can definitely do this (Zuweisung), I have done it several times.
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Old 13.11.2015, 22:49
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Re: Important questions about health insurance?

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One other thing: ask your critically-orientated friends/colleagues (or even EF!) to recommend doctors that they trust. When you are unwell, it would be wiser to get a quick and correct opinion that jumping around seeking opinions. Note that it may take a while to finally see a doctor (especially specialists). Another option is to ask the first doctor if he/she could forward you to another doctor (one of my friends did this).

As for the "the amount reimbursed by the insurer varies according to valid tariffs for your place of residence or work", the answer is in the following sentence: https://en.comparis.ch/krankenkassen...sicherung.aspx
Thanks for the answers, I really appreciate it. I have some followup questions.

By areas, they mean geographic areas ? So, given that my residence is in Lausanne, If I get treatment outside of my area of residence, I would get only reimbursement upto tariffs defined by Vaud ?


Also, I checked I also have a supplementary insurance which should cover psychotherapy. It doesn't cover osteopathy, and I might actually buy that supplement as well for next year.

Another question I have is that, do I still have to pay amount upto my deductible first if I want coverage for something by my supplemental insurance
?

e.g, if supplementary insurance covers psychotherapy, and my deductible is 2500 for the basic insurance, do I still have to incur costs > 2500 franks to be able to use insurance to pay for psychotherapy ?
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Old 13.11.2015, 23:16
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Re: Important questions about health insurance?

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I doubt your insurance will pay for second or third opinions, you will almost certainly have to pay for that.

No, they most likely will. I've seen multiple orthopedic surgeons. Insurance has paid them all.
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Old 13.11.2015, 23:38
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Re: Important questions about health insurance?

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No, they most likely will. I've seen multiple orthopedic surgeons. Insurance has paid them all.
How many of those were just because you wanted a second opinion? I very much doubt they paid for 3 opinions for the same symptom..... even in CH the controls can't be that lax.
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Old 14.11.2015, 08:08
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Re: Important questions about health insurance?

A very short introduction to health insurance in Switzerland:

- Health insurance is mandatory for every resident of Switzerland

- Health insurance following KVG is the absolute rule; KVG defines the extent of medical coverage and a number of rules for franchise and cost contribution (i.e. the extent paid as pay-as-you-go on top of the insurance premium)

Homeopathy is not covered, for instance, osteopathy, chiropractors neither.

- KVG will only refund costs up to the amount that the treatment would have cost at the place of your residence or at the place of your employment (remember that the KVG insurance premiums vary regionally).

- Private add-on health insurance is available on top of KVG. Anything is possible there.

- KVG provides free choice of any doctors approved by the state, be it in private residence, or in hospitals, in any location within Switzerland (http://www.doctorfmh.ch/index_en.cfm).

- KVG does not put any upper limit on the number of visits spent on any medical condition. You can see a fresh doctor every day of the month to look at that same bleeding nose, for instance.

- KVG allows for discount models to reduce the insurance premium paid - PharMed would be one. The health insurance defines rules to which you would have to stick in order not to pay up.

Details:

http://www.bag.admin.ch/themen/krank...x.html?lang=en

https://www.ch.ch/en/health-insurance/

More details:

Simply talk to your health insurance. Coverage is a minefield (and add UVG for accidents and it gets funny).
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Old 14.11.2015, 08:09
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Re: Important questions about health insurance?

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How many of those were just because you wanted a second opinion? I very much doubt they paid for 3 opinions for the same symptom..... even in CH the controls can't be that lax.
There are no checks because it is perfectly acceptable according to the rules.
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Old 14.11.2015, 08:28
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Re: Important questions about health insurance?

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How many of those were just because you wanted a second opinion? I very much doubt they paid for 3 opinions for the same symptom..... even in CH the controls can't be that lax.

I was looking for a surgeon to assess knee osteoarthritis. And to select a surgeon. I didn't see them all at the same time, but within 3 months. And they all had different opinions and strategies. One advised immediate surgery, two advised waiting. As it turns out, I'm waiting. Because of the cost and resources involved in knee replacement as well as the subjectivity in the decision making regarding timing and preparation, i think insurance will pay for second, third opinions. Maybe not 6th or 7th though.

But when I was diagnosed with cancer, the treatment path was clear....no need for another opinion. That's not true in every case, either.

Enough subjectivity in medicine that 2nd or 3rd opinions can be warranted.
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Old 14.11.2015, 08:44
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Re: Important questions about health insurance?

Some insurance companies offer a second opinion service where if a planned non-emergency operation or other complicated procedure is recommended you contact the insurer for a list of independent doctors to evaluate your case and give another opinion. Going through the insurer's Zweitemeinung program means that you do not have to pay the franchise or the self pay portion for the second opinion evaluation.

Here from CSS, for instance:

https://www.css.ch/en/home/privatper...itmeinung.html

(And an English version of their website to boot...)
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Old 14.11.2015, 09:19
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Re: Important questions about health insurance?

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Going through the insurer's Zweitemeinung program means that you do not have to pay the franchise or the self pay portion for the second opinion evaluation.
Payment (non-payment) is actually the key point here - a second (third, umpteenth) opinion can always be had.

In this case one review of the medical records is offered for free (I'd term that second medical opinion light, as this would really be based on the existing records)
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Old 14.11.2015, 13:48
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Re: Important questions about health insurance?

http://www.zentrum-chiropraktik.ch/c...k/wer-bezahlt/

Somit übernimmt die obligatorische Grundversicherung der Krankenkassen die Kosten für die chiropraktische Behandlung als Pflichtleistung. Dasselbe gilt für die Unfall-, die Militär- und die Invalidenversicherung. Patienten benötigen in der Regel keine Überweisung eines Haus- oder Spezialarztes, um ihren Chiropraktor zu konsultieren.
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Old 14.11.2015, 16:13
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Re: Important questions about health insurance?

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By areas, they mean geographic areas ? So, given that my residence is in Lausanne, If I get treatment outside of my area of residence, I would get only reimbursement upto tariffs defined by Vaud ?
Afaik, canton of residence; reimbursed according to the existing tariffs in Vaud. Again, this depends on your specific insurer and the model. Look at all those fine print. Mine does restrict me to canton, except in emergency.

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Also, I checked I also have a supplementary insurance which should cover psychotherapy. It doesn't cover osteopathy, and I might actually buy that supplement as well for next year.
LAMAL covers physiotherapy, but not osteopathy. This is in French, but if you scroll down, you'll find a list of insurance companies that has supplementary insurances with this option: http://www.lacolline-physiotherapie....ons-frequentes

I don't know the answer to your last question. I would think that these two are mutually exclusive. You can have a supplementary insurance with a provider other than the one for the compulsory insurance.
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Old 14.11.2015, 17:14
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Re: Important questions about health insurance?

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http://www.zentrum-chiropraktik.ch/c...k/wer-bezahlt/

Somit übernimmt die obligatorische Grundversicherung der Krankenkassen die Kosten für die chiropraktische Behandlung als Pflichtleistung. Dasselbe gilt für die Unfall-, die Militär- und die Invalidenversicherung. Patienten benötigen in der Regel keine Überweisung eines Haus- oder Spezialarztes, um ihren Chiropraktor zu konsultieren.
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Old 14.11.2015, 17:37
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Re: Important questions about health insurance?

You might want to consider Visana medical insurance, they include free legal insurance for medical claims.

Other companies might also offer this, I have no idea.

I have the Visana HMO policy, it is very good value, and with supplementary insurance, there is free worldwide travel insurance.
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