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Old 17.05.2017, 17:56
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I hate maths

Hi all,
I need an op and I'm trying to figure out what the difference is in cost between algemein or halb-privat (as it seems I have both options). Just had a conversation with my health insurance.

Say the op costs 5k and my deductible is 2k. As i understand it:
a. on algemein I just contribute the remainder of my deductible along with some daily contribution to meals. So that's 2k and a bit.

b. on halb-privat i contribute 20% of the op costs. 20% of 5k is 1k.

Soooooo.....why would i do algemein....? What am I missing??
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Old 17.05.2017, 18:04
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Re: I hate maths

Aren't you forgetting the deductible from the half-private calculation?
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Old 17.05.2017, 18:16
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Re: I hate maths

So, I pay the 20% contribution out of my deductible? I dont get it
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Old 17.05.2017, 18:27
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Re: I hate maths

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So, I pay the 20% contribution out of my deductible? I dont get it
From the way you've described it, and the way I understand it, you pay your 2k deductible, plus the 20% of the op, making 3k in total.
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Old 17.05.2017, 18:30
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Re: I hate maths

That's if you are sure the op will cost 5k. Obviously the more the op costs, the more your percentage will be.
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Old 17.05.2017, 18:35
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Re: I hate maths

Hmm, I think I need to call the insurance again because that's not what it sounded like....
It sounded like for the half private I just pay a flat 20% of the op cost, up to a cap of 4k a year.
So if the op is 5000 I pay 1000, if it's 10k, i pay 2k etc - so if the cost of the op goes above 16k, then i always only pay 4k.

The deductible seems to only apply to a procedure under the "algemein" bracket.

Crikey, why can't they make it simple.
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Old 17.05.2017, 18:37
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Re: I hate maths

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That's if you are sure the op will cost 5k. Obviously the more the op costs, the more your percentage will be.
Indeed, this seems to only makes sense if the op costs between 5 - 10k. Trying to figure out from the hospital what this mallarkey will cost.
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Old 17.05.2017, 18:57
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Re: I hate maths

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Hmm, I think I need to call the insurance again because that's not what it sounded like....
It sounded like for the half private I just pay a flat 20% of the op cost, up to a cap of 4k a year.
So if the op is 5000 I pay 1000, if it's 10k, i pay 2k etc - so if the cost of the op goes above 16k, then i always only pay 4k.

The deductible seems to only apply to a procedure under the "algemein" bracket.

Crikey, why can't they make it simple.
Yes, to be honest I don't understand how it all works. Good luck, I hope you can sort it out and make a decision.
It's bad enough having to have surgery without all this on top of it.
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Old 17.05.2017, 19:27
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Re: I hate maths

With half private, I pay 10% above the deductable, max CHF 700, same as one would have to pay for basic.

Or do you only have basic insurance?

Tom
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Old 17.05.2017, 22:56
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Re: I hate maths

Do you have basic insurance or half-private? You don't have both at the same time.

It sounds like you have basic and they're telling you what it would cost to "upgrade" to half-private. You still owe your deductible, but you pay an additional amount for the upgrade. At least that's how my insurance works.

The questions then would be (again assuming 5K total bill):

Do you pay deductible + 20% of the total bill?
Deductible = 2K
20% of total bill = 1K
Amount you pay is 3K

or

Do you pay deductible + 20% of the remainder after deductible is applied?
Deductible = 2K
Total bill - deductible = 3K
20% of 3K is 600 Francs
Amount you pay is 2,600 Francs

Also you should ask how much the daily contribution to meals is, so you have a more complete picture of what an upgrade would cost. It sounds like the meal contribution is on top of what you pay above.

Whatever you decide, good luck with the op!
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Old 18.05.2017, 11:18
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Re: I hate maths

Thanks so much everyone.
So I have something called "Economy Flex" which means that I can chose between algemein and halb-privat for hospitalisation.
If I have an accident then I get halb-privat as standard, but for some reason I have this option for elective surgery (what a misnomer: i am electing to have this surgery as much as i elected to grow a lump where it should not be).
Anyway, I am hoping to hear back from the insurance today. Thanks!
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