I have just arrived home from work to receive a bill from my basic health insurance provider, CSS. Its for over CHF 2'200.

To cut a long story short I have been to the hospital on a number of occasions over the last few months as I had to have 2 fibroadenomas removed from my breasts. Operation was in March this year. The total for the operation alone was over 22'200, then adding all the previous consultations, tests etc etc, the total cost is pretty high.

My supplementary (private) health insurance is provided by my employer, so I only required to get basic insurance as everything else is covered. No problems there.

All in all I have paid around CHF 800 before receiving this bill, and I opted for a franchise of CHF 2'000. So I figured I would get a bill for the difference, so around CHF 1'200. Am I thinking right?

I don't know whether I had poor understanding of what basic insurance covered, or whether CSS have buggered up. Coming from the UK, this whole insurance thing is pretty new to me.

If the bill is correct, I have to pay. But I start to get really concerned at the fact one of the fibroadenomas has grown back, and I have another hospital appointment on monday to start the whole process again being only 22 I don't really have savings to be paying out bills of this size all the time.

Thanks so much in advance for your advice.

N

Usually the invoices are very good and clearly states what is the total amount and what is what you have to pay and why.

Is it really for the hospital stay? I ask because you say "basic insurance bill" and these days the insurance companies also send out the half year invoices for the insurance coverage.

If your insurance is like mine you have to pay the chosen excess + 10% of the costs of the procedures above that excess.

Yup it is really for the hospital stay - I haven't been to the doctor for anything else. The dates are clearly stated on the invoice.
It states that the bill is for franchise, selbstbehalt, and Spitalantiel.
And CSS send me a statement every time there's something to pay, not periodically.

What you have paid in premiums is immaterial.

Your 'franchise' (excess in English) is an annual amount that you have agreed to pay yourself - set to zero each January 1. So getting all your bills in one year is a good idea. Your health fund will usually pay 90% of bills after the 'franchise' - so CHF2,200 for CHEF,200 sounds right...

Hi

Sorry to hear about your fibro adenomas.

We had a similar "large" bill which were not expecting and although we ended up having to pay, I called the insurance company they were happy to have us pay the amount in instalments.

Hope this helps and good luck with your next appointment.

Kind regards
Nathalie

I'm just curious as to why the costs aren't covered by the company provided policy?

Part of the costs are, private room, best surgeon in the hospital etc, but there are always costs which are sent to the basic, and this is in excess of my fanchise.

If you refer to this part of Comparis all is explained.

Thanks Bloneybear for the link. I am going to go home and do my sums, and see if they got it right.

I heard from a colleague that insurance firms make in excess of 1million a year from sending out incorrect bills, and no one usually checks it out. i'm Scottish, so I like to hold on to my pennies!

Having been involved in the health insurance business I wouldn’t beleive that one. In any case, as far as the basic insurance is concerned, they are non profit making organisations.

After needing a couple of opertations here, I found it better to spend your money on basic insurance with a lower franchaise and then pay for the room upgrade/doctor myself. They will give you your private room if one is free for short stays AND you can choose your doctor by scheduling your operation with them at times when they are working at the hospital.

The scariest thing for me was being told that I needed the operation the next morning and then handed a hospital information flyer that said that this particular operation wasn't covered by insurance. Luckily in the end they did cover it (excl franchaise), and I am with one of the cheapest companies out there.

I think when it comes to the renewal I will go for a lower franchise, just in case there's more hospital 'fun' to come.

As for upgrading, I dont pay anything for supplementary anyway, so not ereally bothered about that. I was at Universitäts Spital Zürich, and was extremely impressed with all aspects of my stay. Would highly recommend the hospital if anyone (unfortunately) has upcoming hospital treatment.

One things for sure, it showed me just how bad the service is from the NHS, and I used to work for them!

If you refer to this part of Comparis you will see (if it comes up in German you can switch it to English)

If you follow the link it details everything that the basic insurance covers.

You should be able to quickly work out the difference in premium for different excess levels from you health fund's info/website. As I recall it was something like if I didn't claim for 16 months, then the increase to CHF1500 fro CHF500 was worth it.

You get what you pay for. Though for high earners the NHS is expensive...

Basic insurance didn't cover the particular operation I needed, but my insurance still covered me.

I really wonder if its really necessary to go for a very high investments right here. Instead there is many medical tourism plans in countries like India, where the cost of operation will not cross more than 4000 to 5000 CHF yet you will get high quality services. Wish you good health...

Medical tourism may be financially attractive for cosmetic surgery, lifestyle treatments etc. These are not insurable in Switzerland. Otherwise, 10% here is usually cheaper than 100% plus travel costs elsewhere.

Hospitalization is often urgent and cannot be scheduled. Also, prolonged follow up treatment may be necessary. And, in times of crisis, it is useful to have relatives and friends nearby. All important reasons for local hospitals.

Looks right to me. As pointed out by other what you are looking at is called coinsurance, this is nothing unusual. Having some experience in Insurance and Healthcare, all I can say is that insurance companies do this to prevent abuse (excesive usage of their Insurance Policy) i.e.: sure we pay but you pay too! In Germany I believe it is the same (at least in nursing homes).

What hits me in the face is that in Switzerland there are no (Health) insurance plans that cover all costs (pay the monthly bill, forget about the rest).

Thats what I was hoping for. Pay now, no worries later