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Old 23.09.2010, 20:03
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Insurance pregnancy help needed!

Have looked through previous posts and have not found my situation so please some help needed.
Long story short, I'm pregnant, due in 2 weeks and all has been relatively normal except a few weeks back I had early contractions so was admitted to hospital for a few days, then sent home. We have basic insurance and have been sending my bills in and been quickly re-imbursed. Our deductable is 2500 but since this is a pregnancy, they have covered most of the doc bills. BUT yesterday we received a bill for 2300sf from the ins. company. Rang them and they said because I was admitted to the hospital and stayed a few days it was considered an 'illness', even though it was pregnancy related, it would not be covered. Had I given birth at the time of my hospital stay it would have been covered as pregnancy.
We assumed and were told anything relating to preg would be covered under basic and there is nothing stating different in the fine print.
The hospital said it is up to the ins co to pay or not..
Can anyone offer some advice!! We can hardly afford an unexpected bill like this so close to me not having an income for many months..
Many thanks!
Tanya
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Old 23.09.2010, 20:08
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Re: Insurance pregnancy help needed!

First of all how can a basic stay is hospital cost 2300CHF? you need to get your doctor to help you with this. I have had lots of insurance issues with them refusing to pay. I recently had to pay a 6000CHF bill for a hospital stay due to small print we missed, this was a private hospital however.

You need to ask your doctor to help you translate the terms and conditions and figure out if there is small print regards hospital stays and pregnancy illnesses, they will try and shaft you but stand your ground and get them to prove to you why you have to pay this amount and such a big amount

What hospital did you stay at and who are your insurers?
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Old 23.09.2010, 20:15
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Re: Insurance pregnancy help needed!

Thanks! My doc's away until next week but will ask him as well. I assume he has nothing to do with the billing as it's all done by hospital admin, no?
I stayed 3 days in Horgen Zimmerberg. Basic insurance with Avenex. The bill was actually higher but the 2300 was the balance to reach my deductable. Ouch! But 6000 an even bigger one!!
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Old 23.09.2010, 20:18
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Re: Insurance pregnancy help needed!

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Thanks! My doc's away until next week but will ask him as well. I assume he has nothing to do with the billing as it's all done by hospital admin, no?
I stayed 3 days in Horgen Zimmerberg. Basic insurance with Avenex. The bill was actually higher but the 2300 was the balance to reach my deductable. Ouch! But 6000 an even bigger one!!
Its not to do with your doc but if he is decent he'll help you out, My Doc has spent countless hours helping me fight my insurance issues. He might be able to help understand why they are saying you should pay, he should also fight the case that your illness was pregnancy related.

I still have no idea how a few nights stay under basic care could cost that much?! I paid 6000CHF for 7 nights in the Hirslanden

If you do pay the 2300CHF that i assume will mean you have no franchise left? once you have paid your franchise then they need to cover the remaining minus 10%? How much of your franchise have you paid already?
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Old 23.09.2010, 20:39
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Re: Insurance pregnancy help needed!

I'm guessing I've paid about 200sf towards my franchise as I've only submitted one or two bills this year.
So do I assume this means ANY future Dr bills this year will be 90% covered??
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Old 23.09.2010, 20:44
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Re: Insurance pregnancy help needed!

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I'm guessing I've paid about 200sf towards my franchise as I've only submitted one or two bills this year.
So do I assume this means ANY future Dr bills this year will be 90% covered??
We have a 300CHF franchise, once we have paid 300CHF then the insurance pays all bills minus 10% up to 700CHF so if in one year we have paid our 300CHF franchise and paid 700CHF from the 10% of each bill then the insurance will pay 100% of the bills

But still you need to fight this bill and find out how they can not cover you? or are you saying they are covering you its just that the amount is within the franchise you owe therefore you have to pay it? If you had a lower franchise then they would pay the bill minus your franchise?
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Old 23.09.2010, 20:48
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Re: Insurance pregnancy help needed!

There is some info here
I had a similar situation and because I was still quite confused I contacted the insurance Ombudsman to clear it up. They said there are 2 areas of pregnancy cover under basic insurance, Special benefits for maternity (covered 100% by basic insurance and not included in franchise) and Complications of pregnancy (included in franchise +10% with a max of 700CHF per year above the franchise).
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Old 23.09.2010, 21:35
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Re: Insurance pregnancy help needed!

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There is some info here
I had a similar situation and because I was still quite confused I contacted the insurance Ombudsman to clear it up. They said there are 2 areas of pregnancy cover under basic insurance, Special benefits for maternity (covered 100% by basic insurance and not included in franchise) and Complications of pregnancy (included in franchise +10% with a max of 700CHF per year above the franchise).
I can confirm too that hospital stays for pregnancy related things (non birth) are covered, but you need to use your franchise first then pay 10% to the max 700 CHF a year. I actually managed to hit my max last year with pre-term labor and an operation after leaving hospital. I'm not lowering my excess from 300chf until i'm done with having babies.

All your doctor's bills are now 90% covered but watch out for meds - check your insurer's online list of non-covered meds. I was on one that was 90 CHF a week and wasn't covered by my insurer because it was a heart condition drug that worked well for stopping contractions.
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Old 23.09.2010, 21:39
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Re: Insurance pregnancy help needed!

hiya ...first you need to get your hospital to contact or write to your insurance and tell them the problem was pregnancy related ..my wife has only 4-6 weeks left or hers and we have not had to pay for anything apart from 2 blood tests .

but 3 years ago my wife , then girlfriend fell into early labour while visiting me here in switzerland , she spent 7 weeks in hospital on drips and drugs to stop our son being delivered , they were fantastic ....the bill be recieved was 58000chf hmmmm but our English E1 11 card was excepted and good old Blighty tax payers paid for it ...we just paid 200 pounds of good will.

normaly 2 nights in a hospital Half private is 350 chf per night stay ( with wetzikon )

E111 will only cover emergency treatment !!
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Old 24.09.2010, 09:24
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Re: Insurance pregnancy help needed!

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First of all how can a basic stay is hospital cost 2300CHF? you need to get your doctor to help you with this. I have had lots of insurance issues with them refusing to pay. I recently had to pay a 6000CHF bill for a hospital stay due to small print we missed, this was a private hospital however.

You need to ask your doctor to help you translate the terms and conditions and figure out if there is small print regards hospital stays and pregnancy illnesses, they will try and shaft you but stand your ground and get them to prove to you why you have to pay this amount and such a big amount

What hospital did you stay at and who are your insurers?
A days' stay in CHUV (Lausanne university hospital) now costs over Chf 1000.-- per day.

Why is it so expensive ? Well begin thinking of all the equipment they need and the amount of highly qualified personnel to run the equipment, then the army of other to assisit and clean up after the highly qualified personnel and it all begins to make sense.
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Old 24.09.2010, 10:55
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Re: Insurance pregnancy help needed!

From what I uinderstand, any treatment outside what is normal for a pregnancy is seen as illness and it goes on to your franchise. The whole franchise system here is a bit of a gamble. The OP has chosen the highest franchise, which has the greatest savings but also carries the greatest risk if things go astray.
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Old 24.09.2010, 11:10
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Re: Insurance pregnancy help needed!

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The whole franchise system here is a bit of a gamble. The OP has chosen the highest franchise, which has the greatest savings but also carries the greatest risk if things go astray.
You either take a high franchise and lower premiums or higher premiums and a lower franchise. At the end of the day there isn't too much in it.

If you're unfortuante and go often to the doctor, it's cheaper to pay higher premiums and lower franchise, if you're fortunate like me and never go, take lowest premium and highest franchise.

A little depends on the amount of risk you want to take and in the case you do need to use your insurance you can pay for the franchise
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Old 24.09.2010, 11:10
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Re: Insurance pregnancy help needed!

Yes i mis-understood originally and thought they were not covering her bill at all - but it seems they are but, obviously she has to pay her franchise first.

We have always had the lowest franchise of 300CHF and pay more per month but it's nice to know you wont get stung for huge bills. For me with many issues I have had lately the 300CHF is a god send. My husband pays 300CHF and never goes to the doctor - I sometimes think he should increase it but then you never know.

One thing that would be annoying is having to pay a huge bill and clearing your franchise in the last few months of the year meaning that you start a fresh in January with your full franchise again. Illness/accidents etc... should happen always in the first few months of the year
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Old 24.09.2010, 11:17
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Re: Insurance pregnancy help needed!

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You either take a high franchise and lower premiums or higher premiums and a lower franchise. At the end of the day there isn't too much in it.
At the end of the day and this I may add this is only a rough guide....

If you take the highest franchise and dont use it, you can save about 1200 a year.

If you take the highest and use it all (like the OP has), you are about 700 chf worse off than if you had taken the lowest fanchise.

Once again, it is a bit of a gamble. Most people sit somewhere in the middle with 1500 franchise, where the savings, loss ratio is about 700/400.

Nevertheless we should all count our lucky stars that we are in a country where you can get first class healthcare, no matter what your income. While it can cost some chuffs, it is available and won't send you or your family bankrupt
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Old 24.09.2010, 11:57
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Re: Insurance pregnancy help needed!

If you had taken the bother to quote the whole of my post, tt's perfectly obvious that if you use your insurance the actual amount paid between franchise & premium will not be so big, it's if you don't use your insurance or do, that's where you need to be careful with your choice and the amount of risk you wish to carry yorself.
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Old 24.09.2010, 12:02
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Re: Insurance pregnancy help needed!

Maybe you have misunderstood my point

I was merely putting some figures in to support what you had said.

In a nutshell in the worst case scenario with a higher franchise you will be 700 chuffs down, IMHO not much in it really.
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Old 24.09.2010, 12:06
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Re: Insurance pregnancy help needed!

Hello Tanya,

I do not know much about the insurance but I would like to suggest to stay calm and leave this matter of payments on your husband/BF to take care of (payments and other stuff can be sorted later on)..... any kind of stress at your stage of pregnancy is not good for you and to your unborn child.

Happy mother give birth to happy and healthy child.
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Old 24.09.2010, 12:36
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Re: Insurance pregnancy help needed!

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Hello Tanya,

I do not know much about the insurance but I would like to suggest to stay calm and leave this matter of payments on your husband/BF to take care of (payments and other stuff can be sorted later on)..... any kind of stress at your stage of pregnancy is not good for you and to your unborn child.

Happy mother give birth to happy and healthy child.
The above comment has made me chuckle. My husband keeps getting annoyed that in books, websites, iPhone apps etc... on pregnancy all the info for dads is purely financial sorting out insurance and stuff, he says it is unfair that he gets all the boring stuff, I told him I'd be happy for him to give birth instead of me
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Old 24.09.2010, 12:49
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Re: Insurance pregnancy help needed!

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The above comment has made me chuckle. My husband keeps getting annoyed that in books, websites, iPhone apps etc... on pregnancy all the info for dads is purely financial sorting out insurance and stuff, he says it is unfair that he gets all the boring stuff, I told him I'd be happy for him to give birth instead of me
Sounds about right to me !
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Old 09.10.2011, 12:33
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Re: Insurance pregnancy help needed!

My insurance company has been a nightmare but ultimately, they have said that they only cover a healthy pregnancy with no complications. Any complications go under your deductible. Your situation sounds like a bit of a grey area, which usually means the insurance company wins.
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