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Old 31.12.2017, 09:29
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Broke bone procedure

I have broken the greater trochanter bone abroad. Foregin doctor that I visited, said that surgery might be necessary. When I return to Switzerland next week can I directly make a appointment with the Orthopedist and go there with my RTG photo or do still need to go via Hausarzt first?
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Old 31.12.2017, 09:44
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Re: Broke bone procedure

The question of whether a referral is needed or not is twofold:. Frst, there is the question of what your insurance allows, second there is the question of how the specialist structures his or her practice.

To the first: what insurance model do you have?

If an HMO you likely need to see your GP, or at least call, as the insurer could say that since you have been able to delay treatment while abroad the situation does not qualify as an emergency.

If Telmed, call as per usual.

If the standard model, you can go and see an ortho on your own and your insurance will still pay.

The second then question arises. Not all specialists will see a self-referred patient, regardless of the patient's insurance type. Many require a GP referral to get you in the door.


If this is an emergency, though - go to the ER on arrival.

Good luck with your recovery.
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Old 31.12.2017, 09:59
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Re: Broke bone procedure

Thank you for quick answer and kind words. I have "Hausarzt" insurance with Assura. It is described on their web site in a following way: https://de.assura.ch/krankenkasse/ae...-kvg-franchise
"Hausarzt - erste Konsultation bei Ihrem Hausarzt. Konsultieren Sie das Ärzteverzeichnis."
I suppose it means that I need to go to GP first
This is a little bit silly because I already know that I have broken bone. I just need a decision whether surgery is needed or not (foreign doctors should call me back on Tuesday with their opinion)
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Old 31.12.2017, 10:04
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Re: Broke bone procedure

Are you allowed to travel with that? Is it safe to travel?

If you chose the insurance to go to a GP first, then you need to visit your GP first
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Old 31.12.2017, 10:09
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Re: Broke bone procedure

If you have the Hausarzt model you need to follow the prescribed procedure or you risk having the insurance deny coverage.

The whole point of that model is that you traded some degree of autonomy for a reduced premium. The GP is the gatekeeper, he or she determines whether or not specialist treatment is needed, that's how the plan controls costs.

In this case the GP will most likely look at your x-rays and refer you on to the appropriate specialist quickly.

Sure, the visit might end up something of a rubber stamp, but you do need to follow the procedure to ensure that your insurer pays for the treatment. When in doubt, call your insurer for instructions.

On the plus side, a GP referral usually gets you in to see a specialist more quickly. Without the referral, you might have a long wait. And as above, many specialists refuse to see patients without referrals, regardless of patient insurance type.
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Old 31.12.2017, 11:23
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Re: Broke bone procedure

One more question. Regarding specialist Orthopedist selection. I have Optima Varia supplementary insurance. It says that I have "Freie Arztwahl" but only in accordance to the list:
https://de.assura.ch/assurance/pdf/e..._2015_d_ec.pdf
List of clinics seems to be quite short and there is no information which clinic has orthopedist specialization. How to interpret list of clinics from Assura site?
Is it possible to check which clinics with Orthopedist specialization Assura has contract with?
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Old 31.12.2017, 11:54
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Re: Broke bone procedure

Presumably this was in an accident of some sort, so you should inform your accident insurance (via your employer if you have one) about this ASAP and arrange an appointment directly with a specialist. It's not necessary to involve your health insurance at all, nor be worried about complying with their restrictions or conditions.

Nor do you need to worry too much about whether an accident report was made when and where it happened. As long as the injury is consistent with an accident (and a broken leg bone surely must be?) and even if you can't remember the exact occurrence you can just go ahead with whatever treatment is required and if will all be covered.
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Old 31.12.2017, 12:03
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Re: Broke bone procedure

Yes it was clearly an accident during bicycle ride. I was taken to medical clinic Emergency

Last edited by pawp; 31.12.2017 at 12:17.
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Old 31.12.2017, 12:22
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Re: Broke bone procedure

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Yes it was clearly an accident during bicycle ride. I was taken to medical clinic Emergency
call your accident insurance and ask what to do and what you are covered for (like private worldwide or not).
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Old 31.12.2017, 13:48
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Re: Broke bone procedure

For a fracture of the trochanter major, surgery is rather likely and probably should not be delayed.

In which country are you now?
(-> reason to ask: availability of healthcare, heard some interesting stories from doctors visiting their home countries and being very shocked at what they found)

Do you have Rega cover?
(-> reason to ask: they have a good medical support service and will fly you home on medical evacuation if needed....they were close to coming to fetch mr HH from USA a couple of years ago)
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Old 31.12.2017, 13:51
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Re: Broke bone procedure

I am currently in Poland
I am not sure if i have Reg(c)a coverage. My employer's accident insurance is with Axa Winterthur.
I heard good opinions about Schulthess Klinik and preferable I would like to be treated there.
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Old 31.12.2017, 14:17
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Re: Broke bone procedure

Rega is a personal insurance not via your employer or health insurance. So probably then you do not have it. Information page here: https://www.rega.ch/en/support-rega/...ga-patron.aspx. They may anyway be willing to support with phone advice if you become a member immediately.

Suggest you call AXA Winterthur for advice and support. And see if someone with you can get a copy of your x-rays from the hospital - ideally electronic copy so you can send it on (give the person who will go to the hospital a permission in writing to receive your medical information)

Of course the action needed depends on the precise diagnosis, and you have mentioned only the fracture, not the severity of it (1mm bone chip vs complete fracture are clearly different things)....but as the hospital that treated you does not have a capability to assess fully (they do not have an orthopaedic surgeon available until Tuesday to review the xray and decide if surgery needed), then personally I would want to take steps to get that proper evaluation as soon as possible.

Good luck!
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Old 31.12.2017, 16:01
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Re: Broke bone procedure

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Rega is a personal insurance not via your employer or health insurance.
No. It's not. It's an independent rescue service funded at least partially by donations from 'patrons'. This does not entitle the patron to any special assistance and is not in any way a part of any insurance cover.

If repatriation is needed it is solely down to the accident insurer to organise and cover this. In some cases REGA may be involved in the repatriation, but they're not doing so as a service to patrons - they'd normally only become involved if they were seen as the best resource for the job required, and there services would be paid for by the accident insurer.
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Old 31.12.2017, 16:20
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Re: Broke bone procedure

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I have broken the greater trochanter bone abroad. Foregin doctor that I visited, said that surgery might be necessary. When I return to Switzerland next week can I directly make a appointment with the Orthopedist and go there with my RTG photo or do still need to go via Hausarzt first?
Step 1) You are insured for accidents through your employers AXA accident insurance
Step 1a) Get it fixed - your employment contract will probably specify that you are covered for private insurance
Step 1b) Contact your employer (phone / email) on where the invoices should be directed (they will be directed to AXA)

Why are you asking on EF and not your Health Insurance / Krankenkasse ???

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Old 31.12.2017, 16:29
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Re: Broke bone procedure

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Step 1) Get it fixed
Step 1 a) Call your Krankenkasse to ask how the bills will be paid

Why are you asking on EF and not your Health Insurance / Krankenkasse ???
Accidents are not usually covered by health insurance, unless you don't work.
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Old 31.12.2017, 16:38
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Re: Broke bone procedure

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Accidents are not usually covered by health insurance, unless you don't work.
The Op is covered by his employers AXA accident insurance!
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Old 31.12.2017, 16:41
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Re: Broke bone procedure

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The Op is covered by his employers AXA accident insurance!
Indeed, so calling his krankasse would be a waste of time.
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Old 31.12.2017, 16:57
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Re: Broke bone procedure

@ OP

I also had no idea of these things when arriving in CH.

Hope that you've got your injury sorted out. You've said that your employers accident insurance is with AXA, so probably you will have great coverage in dealing with it under private accident insurance.

Usually, you just give your usual Krankenkasse + AHV No. and the hospital sorts it out, and directs the bills to your employers insurance.

Let your employer know about the injury right now, and they will probably sort out the paperwork for you.
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Old 31.12.2017, 19:03
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Re: Broke bone procedure

When I've had accidents, I've gotten an accident report form and insurance contact (email address) from my employer. Send them the form, basically just a description of what happened, get a claim number back. Said claim number makes all the doctors happy. No problem giving them the number a few days after the initial visit/treatment - so long as the insurance was in force at the moment of accident, the insurer is on the hook and everybody knows it.

You should find out if your employer's accident coverage is private level (includes supplemental insurance) or public. The former means a greater choice of doctors, private room if you need time in the hospital, etc. However, if you ask for private level treatment and you only have public accident insurance, then you might need to pay out of pocket.

Either way, there should be no problem just calling the relevant department at Schulthess, Balgrist, etc, for an appointment.
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