View Single Post
Old 21.08.2021, 12:16
bmczattar bmczattar is offline
Join Date: Mar 2018
Location: Basel
Posts: 7
Groaned at 0 Times in 0 Posts
Thanked 4 Times in 2 Posts
bmczattar has earned some respectbmczattar has earned some respect
High risk pregnancy medications/ exams reimbursements

Hello everyone,

Iím currently in my 20th week of pregnancy, and due to my medical history, the obgyn stated it is a high risk one.
For my specific case, since week 5 Iíve had to take daily anticoagulants prescribed by the doctor, including Clexane (enoxaparin) and Aspirin.

I have premium health insurance from Assura (the most basic model) and supplementary from Sanitas.

I would appreciate your advise with the following questions:

1) Iíve been purchasing the required medication from pharmacies which were near my home/ the doctorís practice. Assura refused to reimburse all the invoices I sent them so far, claiming that these were unauthorized stores. Unfortunately only now I realized that my insurance model has that horrible restriction...
Is there a way to turn this around and get the reimbursement?
BAG states that all required additional exams + medication connected to high risk pregnancies must be covered by the basic insurance. Therefore, although I made a mistake and did not follow Assuraís policy, this situation seems extremely unfair.
In case Assura continues to refuse to pay, could I somehow get the reimbursement through my supplementary insurance (which is Sanitas)?

2) Unrelated to the high risk pregnancy: in the 1st trimester screening, the doctor requested in the blood tests the standard assessment for trisomy risk, and also additional tests for IgM and IgG for infections (toxoplasmosis, cytomegalovirus and rubeola).
Assura covered the costs for the first part, but not for the infections. Is this standard? Could the supplementary insurance cover these remaining tests which were not covered by the premium?

Thanks in advance for the help.

Kind regards,
Reply With Quote