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Old 25.03.2011, 22:31
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Referral for treatment outside canton of residence?

Hi,

Hoping someone can answer this question for me...

I have mental health problems. I am also a Christian and my mental health problems affect me spiritually. My psychiatrist has said to me that she cannot help me with the spiritual aspect, and she realises that that means that there are issues she cannot resolve. My pastor has said that he does not know how to help me because he can only approach the problem spiritually... and to be frank this just makes things worse.

I feel I need treatment from someone who can approach the issue from both sides - the Christian and the psychiatric. So I did a google search and found a psychiatric clinic called 'Sonnenhalde' near Basel (I live in Vaud).

I rang them up and was told that I would need to check my insurance to see if I could be treated out of canton. I have basic assurance with Assura. I can't find anything on their website, but according to the Health Insurance FAQs at the top of this page I would not be covered.

But the person I spoke to at the clinic said that if my insurance wouldn't normally cover it, if my psychiatrist could get the 'cantonal doctor' to write a letter or something saying I had to be treated there the insurance would have to cover it...

It was a little unclear as her English wasn't great and my German is non-existent. So I'm just wondering, does anyone know anything about this process, how to go about it etc? I'd like to have something more to take to my psychiatrist than 'Can you contact some doctor who I don't know and say I need to be treated here?'!

Thanks,

V
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Old 25.03.2011, 22:52
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Re: Referral for treatment outside canton of residence?

First of all does the doctor in Basel speak English well enough to help you? Of course they will claim to be able to help you as they would like to earn the extra money: extra-cantonal rates are not fixed by laws or agreements, they can charge you what they like!

In my opinion you are walking a very fine line in seeking treatment outside of your home canton. You haven't paid for this "luxury" and I can see your insurance Assura refusing to pay anything towards the cost of the doctor in Basel.

The problem basically is that your insurance does not want to spend more on you than they would if you stayed in Vaud. If you can ask your doctor in Vaud to speak to the doctor in Basel, then yes you might get something agreed between them, in that the Basel doctor sub contracts to the Vaud doctor.

BUT, you first need to ask your insurance broker if you will be covered anyway by the future extra work, as most basic policies only cover a certain number of hours (that is psychiatric costs), in any calendar year Jan to Dec.

I think you might have more success in moving to Basel in December and starting off 2012 with the new doctor - if he is suitable.

.
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Old 25.03.2011, 23:00
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Re: Referral for treatment outside canton of residence?

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First of all does the doctor in Basel speak English well enough to help you? Of course they will claim to be able to help you as they would like to earn the extra money: extra-cantonal rates are not fixed by laws or agreements, they can charge you what they like!
.
I asked the member of staff at the hospital and she said there would be someone at the clinic who spoke English... although she also said I would have to go for an initial appointment to discuss if / how they could help me.

Quote:
BUT, you first need to ask your insurance broker if you will be covered anyway by the future extra work, as most basic policies only cover a certain number of hours (that is psychiatric costs), in any calendar year Jan to Dec.
You only have a certain number of hours? No-one told me that! Does that include hospitalisation? I have about 13 hours treatment a week, what with therapy groups and ergothérapie and sessions with my psychiatrist... Where can I found out how many hours are covered by my insurance?

Quote:
I think you might have more success in moving to Basel in December and starting off 2012 with the new doctor - if he is suitable.
Moving to Basel isn't really an option... don't speak the language and therefore I doubt I'd find a job there... when I get well enough to work that is, which at the moment isn't looking likely any time soon
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Old 25.03.2011, 23:19
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Re: Referral for treatment outside canton of residence?

Would it be possible to go home and get treatment for a few months there and then come back?
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Old 26.03.2011, 00:51
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Re: Referral for treatment outside canton of residence?

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BUT, you first need to ask your insurance broker if you will be covered anyway by the future extra work, as most basic policies only cover a certain number of hours (that is psychiatric costs), in any calendar year Jan to Dec.


You only have a certain number of hours? No-one told me that! Does that include hospitalisation? I have about 13 hours treatment a week, what with therapy groups and ergothérapie and sessions with my psychiatrist... Where can I found out how many hours are covered by my insurance?

Moving to Basel isn't really an option... don't speak the language and therefore I doubt I'd find a job there... when I get well enough to work that is, which at the moment isn't looking likely any time soon
For the number of hours covered by the insurance, you should read your policy, or look on the Assura website. Maybe they will differentiate between doctors and therapists. It is certainly limited with Visana.
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Old 26.03.2011, 01:18
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Re: Referral for treatment outside canton of residence?

I have looked at the Assura website and cannot find any mention of pschychiatric costs with the Basis insurance, so presumably they are ALL covered under the government approved general insurance. I am sorry to have misled you.

But what I did find is that with the extra insurance (Complementa Extra) they will only pay up to Fr 1'500 per year for a qualified therapist, if a doctor prescribes this.
http://www.assura.ch//web/assura/Con...stations_F.pdf

Google translation: Up to 100% of gross billings of CHF 1'500 .- per year
civil, and costs resulting from medical treatment
prescribed and provided by non-physician psychotherapists
and independent psychologists on the list established by
the umbrella organization of Swiss health insurers.
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Old 28.03.2011, 15:30
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Re: Referral for treatment outside canton of residence?

Thanks for the update... after I'd calmed down a bit I realised that seeing as I'd spent 4 months in hospital last year and seen my psychiatrist once a fortnight outside that and done a 20 week therapy group and also gone to ergothérapie twice a week... it was probably all covered!

As for why I don't go home...

"Your problem is that you are weird because you are single and a Christian. Go to the library and read these books."

That was all the psychiatric help I got for 3 years... I'm not kidding. I wish I was.
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