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Old 24.05.2016, 11:00
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Complement or not the basic insurance?

Hi!

My husband will soon be beginning his 5th year of "temporary posting" in CH, and as such we have to switch from BUPA + some sort of (mostly theoretical cover) from Norway over to the Swiss system.

The basic insurance system I've already figured out, now we just have to find the right arguments to convince the employer that the HMO model isn't suited for us but that we want the GP model where we can keep our current GPs. Travel insurance is also being taken care of.

I'm somewhat more insecure about the complementary insurance.From what I read, the basic insurance is pretty much like the cover we would get in Norway or in Québec, i.e. adequate care in not overly luxurious conditions. Which begs the question, is there any point at all in taking a complementary insurance?

And if yes, what do you experienced EFers consider the most important elements of the complementary insurance?

How difficult is it to get complementary insurance to begin with? The way I see it, me being overweight might be a problem, although I have absolutely no health issues and can't remember last time I went to the doctor for an actual illness. Husband has bad allergies, but that would fall under the basic insurance. The Troll is above 7, so my understanding is that he wouldn't be covered for braces by an additional coverage for dental care.

Which makes me wonder whether it's wouldn't be more appropriate to save the money in a separate account instead of fattening the insurance companies instead of taking up a complementary...
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Old 24.05.2016, 11:24
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Re: Complement or not the basic insurance?

I have supplementary insurance and I never regretted it. I have problems with my back and they cover 75% of the therapy (read massage costs), which can be up to CHF 200 per visit. They might or might not take you though, depending on your health.
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Old 24.05.2016, 11:28
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Re: Complement or not the basic insurance?

My experience is that any previous illness can lead to non acceptance of the complementary insurance. I have a thyroid issue so my application for complementary insurance was denied, even though I have no problems with my thyroid, need to take one pill a day only and have a blood test once a year.


If you can get it and it is not too expensive? Go for it if you expect some visits to the doctor. I just save some extra money and last time I had an OP I bought an "upgrade", was cheaper than paying the monthly fees.
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Old 24.05.2016, 11:39
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Re: Complement or not the basic insurance?

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convince the employer that the HMO model isn't suited for us but that we want the GP model
That should not be anything that the employer is concerned about.

If you want to make an "exciting" deal, then simply negotiate something like CHF 400 per family member as "health insurance component" (which would be taxable as it is income)

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is there any point at all in taking a complementary insurance?
It's a total intransparent mess.

Every insurance company creates their own product and their own product bundles, with differing prices and services offered. And you can mix KGV (basic) insurance from any company with any number of completely independent products from any number of other insurance companies.

And as complementary insurance is per person, any family member can pick his/her own bundle with their own preference of insurance company.

Now, having said that, you need to build up expectation on what you _want_ to have covered. Try to approach this by picking any one of the large insurance companies and see whether one of the "features" offered is something that you'd be willing to pay for. After you have identified the feature set, go shopping for prices.

Does it "pay off"? Well, that's impossible to tell and that's why the concept of insurance exists at all. It would be called "savings plan" otherwise ("self-insurance"), as you mentioned indirectly already.

From my point of view, the basic health insurance in Switzerland covers everything that an average person needs. Make sure that you are covered for any non-average behaviour, e.g. long trips abroad to expensive destinations, or rescue operations due to sports, and you will do well.

FWIW - some (large) enterprises have corporate agreements on complementary insurance, reducing the cost of such insurance. (Such agreements are not permissible on KVG policies)
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Old 24.05.2016, 11:39
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Re: Complement or not the basic insurance?

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My experience is that any previous illness can lead to non acceptance of the complementary insurance. I have a thyroid issue so my application for complementary insurance was denied, even though I have no problems with my thyroid, need to take one pill a day only and have a blood test once a year.


If you can get it and it is not too expensive? Go for it if you expect some visits to the doctor. I just save some extra money and last time I had an OP I bought an "upgrade", was cheaper than paying the monthly fees.
If I understand you correctly, they either deny you altogether or they accept you, there is no in-between where they might accept you with some exclusions? I've never been to hospital except to give birth, never had any serious illness either. In my family you either die young or live ridiculously old, we apparently don't do the in-between.

Where I come from, nothing that is covered under the complementary would be covered anyway so I'm not sure whether it's an unnecessary luxury or not... All our Swiss friends have it, but then again they are Swiss and have different expectations from the health system than Norwegians and Québecois would have.
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Old 24.05.2016, 11:44
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Re: Complement or not the basic insurance?

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I have problems with my back and they cover 75% of the therapy (read massage costs).
Physiotherapy (medical massages) can be prescribed by a medical doctor, under full coverage by KVG.
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Old 24.05.2016, 11:44
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Re: Complement or not the basic insurance?

Correct, they do not exclude anything, they just deny the extra insurance (in my case). I know in other countries they could exclude a previous illness or raise the monthly fee.


I am happy with the basic insurance, it has covered what I need and as said, if I want more when in hospital, I pay for an upgrade,
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Old 24.05.2016, 11:46
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Re: Complement or not the basic insurance?

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That should not be anything that the employer is concerned about.

If you want to make an "exciting" deal, then simply negotiate something like CHF 400 per family member as "health insurance component" (which would be taxable as it is income)



It's a total intransparent mess.

Every insurance company creates their own product and their own product bundles, with differing prices and services offered. And you can mix KGV (basic) insurance from any company with any number of completely independent products from any number of other insurance companies.

And as complementary insurance is per person, any family member can pick his/her own bundle with their own preference of insurance company.

Now, having said that, you need to build up expectation on what you _want_ to have covered. Try to approach this by picking any one of the large insurance companies and see whether one of the "features" offered is something that you'd be willing to pay for. After you have identified the feature set, go shopping for prices.

Does it "pay off"? Well, that's impossible to tell and that's why the concept of insurance exists at all. It would be called "savings plan" otherwise ("self-insurance"), as you mentioned indirectly already.

From my point of view, the basic health insurance in Switzerland covers everything that an average person needs. Make sure that you are covered for any non-average behaviour, e.g. long trips abroad to expensive destinations, or rescue operations due to sports, and you will do well.

FWIW - some (large) enterprises have corporate agreements on complementary insurance, reducing the cost of such insurance. (Such agreements are not permissible on KVG policies)
Thanks!

The reason the employer is concerned is that they will be paying, as they have the obligation to ensure that we have a similar cover to what the Norwegian Folketrygden would offer as long as we are here as expats. What makes our situation complicated is that we're passing the magic 5 years limit where they have to enrol us in the local schemes (for pension as well for instance), and they have no clue as to how the system here works. The Norwegian HR lady just went to Comparis and picked the cheapest option she could find, she doesn't even know what an HMO is. We have very good GPs that speak languages we understand, for us it's just not an option to go HMO.

Complementary will be on us if we decide to get one. Still not sure what we'll do, tending towards not taking up one, but will probably apply just to see if we can get one and how much it would cost.

Travel insurance and cover for accidents we have through the employer for one more year, after that we're on our own and will of course get one as we travel a lot.
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Old 24.05.2016, 11:47
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Re: Complement or not the basic insurance?

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Hi!

My husband will soon be beginning his 5th year of "temporary posting" in CH, and as such we have to switch from BUPA + some sort of (mostly theoretical cover) from Norway over to the Swiss system.

The basic insurance system I've already figured out, now we just have to find the right arguments to convince the employer that the HMO model isn't suited for us but that we want the GP model where we can keep our current GPs. Travel insurance is also being taken care of.

I'm somewhat more insecure about the complementary insurance.From what I read, the basic insurance is pretty much like the cover we would get in Norway or in Québec, i.e. adequate care in not overly luxurious conditions. Which begs the question, is there any point at all in taking a complementary insurance?

And if yes, what do you experienced EFers consider the most important elements of the complementary insurance?

How difficult is it to get complementary insurance to begin with? The way I see it, me being overweight might be a problem, although I have absolutely no health issues and can't remember last time I went to the doctor for an actual illness. Husband has bad allergies, but that would fall under the basic insurance. The Troll is above 7, so my understanding is that he wouldn't be covered for braces by an additional coverage for dental care.

Which makes me wonder whether it's wouldn't be more appropriate to save the money in a separate account instead of fattening the insurance companies instead of taking up a complementary...
Is the Troll your child age 7?

Otherwise the main thing to get is coverage throughout Switzerland. Basic only covers you for the Canton of residence. If possible and desired, also get worldwide coverage, including transport back to Switzerland.

Also, within the basic coverage there is no need to go with an HMO. You can also choose the house doctor or standard models.

Being overweight shouldn't be an issue (but it may depend by how much).

Also, I try to keep the complementary at the same company. Makes it easier with the claims. But it's not mandatory.
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Old 24.05.2016, 11:53
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Re: Complement or not the basic insurance?

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The Norwegian HR lady just went to Comparis and picked the cheapest option she could find,
As mentioned, negotiate a budget and then pick _yourself_ whatever suits you. This allows you to change insurance companies and insurance models, too.

Keep in mind that the cost for health insurance goes up every year (they expect a 10 per cent increase this year) and that health insurance also depends on location of residence (the village on the other side of the hill is more expensive than my place, for instance, all other things being equal)

https://en.comparis.ch/krankenkassen...e/hitlist.aspx might also help.
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Old 24.05.2016, 12:45
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Re: Complement or not the basic insurance?

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Is the Troll your child age 7?

Otherwise the main thing to get is coverage throughout Switzerland. Basic only covers you for the Canton of residence. If possible and desired, also get worldwide coverage, including transport back to Switzerland.

Also, within the basic coverage there is no need to go with an HMO. You can also choose the house doctor or standard models.

Being overweight shouldn't be an issue (but it may depend by how much).

Also, I try to keep the complementary at the same company. Makes it easier with the claims. But it's not mandatory.
Yes, it's our son. No health issues, but we've started saving for braces since we know he's likely to be too old to get coverage if we stay. In Norway standard braces for kids are covered by the public healthcare system, now that we've been here "too long" we're out of coverage.
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Old 24.05.2016, 12:48
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Re: Complement or not the basic insurance?

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Yes, it's our son. No health issues, but we've started saving for braces since we know he's likely to be too old to get coverage if we stay. In Norway standard braces for kids are covered by the public healthcare system, now that we've been here "too long" we're out of coverage.
He's not too old. He can be covered no problem. Check out comparis.
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Old 24.05.2016, 13:09
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Re: Complement or not the basic insurance?

My 2p/5Rp, based on my experiences:

If you can qualify for supplementary insurance get it now. Because when you need/want it later, you will likely no longer qualify.

Yes, under our insurance company being overweight is a disqualifier, measured by BMI. One might be allowed to re-apply after a defined period if the weight is lost, and that loss is certified by a physician. Coverage for weight-related conditions might still be excluded. Again, though, each insurer likey has different policies.

Yes, I know that many EFers are happy with only basic. Hopefully you will be too.

But my experience has been otherwise. The local hospitals here do seem to enforce that an Oberarzt or Chefartz will only treat those with semi- or private insurance.

Again probably a local difference, but here one can pay for an upgrade to accomodation in the hospital, but not for an upgrade to care provider. If you wish to be treated by a more senior doctor than your insurance allows you'd have to go fully private.

But again, I would expect that practices differ widely. As above, other EFers have had very different experiences with basic insurance.

But the over-riding reason I would want to have supplemental insurance is that the Powers That Be may be taking some procedures out of basic coverage. See this thread, for instance:

Basic Insurance: Proposed Evaluation of Currently Covered Treatments
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Old 24.05.2016, 13:46
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Re: Complement or not the basic insurance?

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Yes, it's our son. No health issues, but we've started saving for braces since we know he's likely to be too old to get coverage if we stay. In Norway standard braces for kids are covered by the public healthcare system, now that we've been here "too long" we're out of coverage.
Our son was 10 when we moved here and we managed to get dental cover for him. The orthodontic cover was more limited as we could only have what was covered in the dental package but it did cover 90% of his braces when he needed them a couple of years ago.

You can get supplementary cover with certain exclusions, it depends on the company and the medical condition involved.
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Old 24.05.2016, 14:15
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Re: Complement or not the basic insurance?

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Physiotherapy (medical massages) can be prescribed by a medical doctor, under full coverage by KVG.
That's not necessary the case. Many physiotherapists are covered only under complementary insurance.
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Old 24.05.2016, 14:28
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Re: Complement or not the basic insurance?

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That's not necessary the case. Many physiotherapists are covered only under complementary insurance.
Cross-talk.

I say: Physiotherapy can be prescribed.

You say: Some people doing things that a physiotherapist would do are not recognized as qualified physiotherapists under the regulations of KVG and thus cannot bill health insurance on the prescription.
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Old 24.05.2016, 14:41
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Re: Complement or not the basic insurance?

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Cross-talk.

I say: Physiotherapy can be prescribed.

You say: Some people doing things that a physiotherapist would do are not recognized as qualified physiotherapists under the regulations of KVG and thus cannot bill health insurance on the prescription.
You said "Physiotherapy (medical massages) can be prescribed by a medical doctor, under full coverage by KVG"

I said "Many physiotherapists are covered only under complementary insurance"

1) One does not need a prescription to use the services of health care professionals covered under complementary insurance as 2) The insurer will only take over the costs only if one has supplementary insurance anyway.

Sample from a website of a gentleman I went to in 2014:

Rolfing® will be covered by your Swiss health insurance if you have the complimentary medicine plan, "Zusatzversicherung." Call your health insurance to find out how much exactly will be covered towards Rolfing.
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Old 24.05.2016, 14:48
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Re: Complement or not the basic insurance?

@Trollemor
This post goes beyond your original question, and I realise you already know some of this info. However, I’m posting in this detail since the discussion in your thread has now become somewhat broader, and in case this helps others, too. Hope that’s okay.

Officially and by law, the coverage provided by the basic health insurance (Grundversicherung) is the same, regardless of the insurance company. In reality, it can differ widely. From very much anecdotal experience, my own and that of people I’ve know for years, it seems to be worth it to be insured with one of the main, stable, large medical insurance companies. The others may be somewhat cheaper, but do not necessarily have the financial basis to actually cover anything that is more complicated than black-and-white. Having said that, this is not the advice I would give to, say, a young, strong, healthy person planning to stay in Switzerland for just one year, for the experience. For a family, though, and indeed for any adult over 35, I’d say: go for what is old-school reliable.

The Grundversicherung (basic insurance) is obligatory. Within this, you can freely choose to see any doctor within your Canton. The following explanations refer to the Grundversicherung.

Franchise and Selbstbehalt
You always have to pay the first slice of your treatment, per calendar year. This is called the “Franchise”. The minimum franchise (for adults) is Fr. 300 per annum. Even though you will have to pay those first bills of the year, amounting to your franchise, you should submit them to your medical insurance company (so they can see you’re paying them). Once that’s done, the medical insurance will thereafter cover 90% of the costs of (most) subsequent bills, i.e. you always pay 10%. This 10% is called the “Selbstbehalt” (literally: part reserved for you to hold). Thankfully for anyone who is often (or long-term) ill, the Franchise and the Selbstbehalt, added together, have an upper limit. For example: Franchise of Fr. 300 plus Selbstbehalt 10% up until the sum of these two reaches Fr. 1000 (paid out of one’s own pocket) per annum. Thereafter, the medical insurance pays the full bill, not just 90%.

You can have your monthly premium reduced if you choose to live with certain restrictions.
One of these is to set the franchise higher.
Another is to submit to the so-called “HMO model”, which means that, no matter what your medical needs are (except for gynaecological) you must always, always first go to your GP (Hausarzt) or a group practice of several GPs. Which practice is specified by your insurance company. That GP then refers you to a specialist – or does not.
Both of these options can be necessary for those who simply do not have enough money to pay the monthly premiums. However, precisely for people with a low budget, having a high franchise (e.g. Fr. 2000 per annum) can make things very difficult, as the decision to go to see a doctor at all can be very expensive.

If you wish to maintain your freedom to being allowed to choose any doctor you want, within your Canton, then you should not go for the HMO model.

Now to your actual question of additional insurance over and above the obligatory Grundversicherung.
If you would like to extend your freedom to being allowed to choose any doctor you want, within the whole of Switzerland, then you should buy the top-up “ganze Schweiz”.

For hospitalisation, the Grundversicherung covers the “allgemeine Abteilung” (= general ward). Typically, a general ward has 2, 3 or 4 beds per room, with those patients sharing a shower and toilet with direct access from within the room. In some older hospitals, it may still be the case that there could be 6-bed rooms, and/or a shower and toilet down the passage. Even in a general ward, there are usually services which, in many countries in the world would be unthinkable, such as a hand-basin, endless fresh linen and towels, a selection of meals and a telephone at one’s bed.

As others have pointed out, the very senior-most doctors do not deal directly with the medical treatment of patients with Grundversicherung (in the “allgemeine Abteilung”), though they do supervise the other doctors and would be involved if a case were deemed to be particularly complex. To get the very top qualified doctors, one must have a higher level of insurance, the next step up being “Halbprivat” and the top level being “Privat”.

Depending on the hospital, and besides the level of doctor’s expertise, Halbprivat and Privat also bring advantages in the types of meals that can be ordered, whether or not one is given a dressing-gown to use, etc. and most especially in the number of patients per room. A patients with “Privat” insurance typically has a room to him/herself. For not non-medical aspects (called the “Hotellierie”), it is possible to upgrade to Halbprivat or Privat for a particular hospital stay only, usually at a tariff of around Fr. 250 to Fr. 500 per day. That can be worth it if one can afford it, if one’s suffering is great and especially if the shared hospital room is too noisy.

There is another aspect to having Halbprivat or Privat insuance: some specialised hospitals do not ever admit patients with only Grundversicherung. Or patients who pay for the upgrade as above. This is particularly applicable in some types of Rehab clinics (for detox from drugs, from alcohol, but also for post-operative or post-illness recovery) and for some psychiatric clinics (especially but not only those dealing with burnout, or those with special facilities such as a thermal bath), and perhaps for some maternity institutions (= in which to give birth). In addition, some surgeons with their own practice will operate only in private hospitals. This means that a surgeon may well see someone who has Grundversicherung in his/her practice, but that the operation itself would have to take place at a considerable additional charge (for upgrading) in a private hospital. Or else that the surgeon gives her/his opinion, but then delegates the operation to another doctor working in a hospital with general wards.

Another top-up to the Grundversicherung can be interesting, and that is for alternative treatments. Depending on your cultural background, you may be surprised which items are included in the Grundversicherung, which you might have considered alternative (e.g. psychotherapy by a psychiatrist, or physiotherapy, or acupuncture by a medical doctor) or which are excluded which you might have considered mainstream (e.g. art therapy or homeopathy by a practitioner other than a medical doctor, or a contribution to the cost of glasses/spectacles or contact lenses). As has been said before, it is well worth looking up the lists to see what you consider should be in the bundle, or not.

Many of the rules for children are different than those for adults.
About dentistry: while adults have to pay, themselves, or buy expensive dental insurance (once, of course, they have an up-to-date status) for children, there may be reasons why certain orthodontic measures which are considered as usual treatment of certain conditions present at birth. I am not aware of an age limit to this, except, of course, turning 18 and becoming an adult.
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Old 24.05.2016, 21:20
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Re: Complement or not the basic insurance?

I'm grateful to you all for giving me food for thought. Who said EFer aren't a helpful bunch? I'll discuss this with the guy who pays the bills and highlight the pros and cons to him. Coming from countries with a close to 100% healthcare structure, we have to look into our options and figure out what we consider luxury and what we really deem as important.

For instance, about the possibility of being treated by a senior doctor, where we come from it's not something you get to decide. The big guy sees you if your case is serious enough, if not you get the doctor who's available. Never occured to me it could be otherwise before.

Not used to have so much "decision power over my own healthcare", as I said, food for thought.

Thanks again, and a good evening to you all!
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Old 24.05.2016, 21:37
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Re: Complement or not the basic insurance?

For me the principle advantage of supplementary is choice of doctor. If you expect at some point to need some kind of surgery in life then doctor choice can be important because only chain doctors will do certain operations for example new emerging treatment types etc. it is worth the extra to know then if or when you do need to go under the knife you can pick from Switzerland the person who will do it and ensure y out are getting someone with years of experience in your particular procedure.
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