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Old 22.10.2011, 08:43
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Questions regarding the Telmed model

Hey everybody, I'm kind of new here and still trying to figure out this whole health insurrance system. I have gone over the FAQ thread but still have a question regarding the Telmed model...

Do I need to call their hotline number everytime I want to go to a doctor, or does this procedure begin only from the moment I have reached my franchise?

Also, from what I understood the companies can't guarantee that there will be an english speaking person on the phone however in most cases there is?

Thanks in advance for your help...
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Old 22.10.2011, 10:04
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Re: Questions regarding the Telmed model

Welcome to the forum. It would be great if you would start a new thread and introduce yourself here

http://www.englishforum.ch/introductions/



Here's a link to a previous discussion... (where I probably said the same thing I'm saying below but whatever)

Telmed option - your experience ?

We've had the telmed model with innova for the last 4.5 years. It saves us some money -

Some people have better experiences than others, but ours has been innocuous. It is true that when you call, you may not find an English speaking person, although one usually appears after a brief wait. The exception might be cold and flu season when they are slammed. The idea is that by calling them, they may be able to treat you for things like cold and flu rather than have you go to a doctor's office, or to emergency. They are gatekeepers in a sense, but so flimsy in our experience that the savings are worth it to us.

There are a number of call centers, the one we use is Medgate. They are staffed with people who man the phones and a few consulting physicians.

When we call, we have two options - announce an appointment or ask for a consultation. Sometimes for a new issue they will ask if you want to have a consultation - a physician who will call you back, usually within an hour (if he/she does not, call back). The physicians speak English.

I have health issues and so when I call, it's always to announce an appointment, so I say this is related to "blah blah" or I need to have a checkup for "blah blah". I tell them the doctor and the date of the appointment, they usually give me 2 more without calling in the 3 month period (they use quarters ending in March, June, October, December). So I don't have to call again if I see the doctor once or twice more within that period.

This year, I had to go to the doctor weekly, and have some treatments daily for a short time. It would have made me nuts to have to call every three days, so I asked them at the start of the year what could be done. They opened a window for me so I didn't have to call for any of my treatments in a particular hospital (this included doctor's visits) for this calendar year.

When we first moved here, I think we saved about 25% on our premiums. This year, since we've moving to Zurich and our insurance will increase, we save maybe 15%. Because I've had such a complicated year with health care, and it's worked so well with insurance, we'd rather pay the increase than look for another insurer. I used to work in a hospital with a nurse triage center so the telmed concept doesn't bother me.

You might also be interested in the Hausarzt (family doctor, GP) model, where your family doctor is the gatekeeper and refers you to all specialized care, or the HMO model where you get your care in specific clinics designated or run by the insurer. These are both effective if you are comfortable with your hausarzt or clinic (hard if you don't have one yet), could be a problem if you wanted particular specialists.

We've fouind the Telmed model to work well for us, and it saves some money. We like the service of our current insurer so we're willing to bear the cost increase.
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