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Old 16.11.2011, 22:45
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Does my insurance cover hospital stay when I give birth?

I was talking to a friend the other day and she brought up that her health insurance did not cover her hospital stay when she gave birth, which had her a little peeved. As I'm due in about 3 weeks... this led me to have a look at our insurance policy a little more closely. I will copy and paste as is (in German)
Artikel 10 Mutterschaft
Die Assura übernimmt neben den Kosten für die gleichen Leistungen wie bei Krankheit:
a) die Kosten für 7 Kontrolluntersuchungen während der sowie 1 Kontrolluntersuchung zwischen der 6. und10. Woche nach der Schwangerschaft;
b) die Kosten für die Geburtshilfe durch einen Arzt oder eine Hebamme im Falle einer Entbindung zu Hause sowie für das hierzu benötigte Material;
c) einen Betrag von Fr. 100.-- für Geburts- vorbereitungskurse, welche von Hebammen durchgeführt werden;
d) die Kosten für maximal 3 notwendige Stillberatungs-sitzungen;
e) die Kosten für die Behandlung und den Spitalaufenthalt des gesunden Neugeborenen, solange es sich zusammen mit seiner Mutter im Spital aufhält.
Now... My German is just enough for me to understand most of this but just to be sure... does point e up there mean that they will pay for treatment of a healthy baby while in hospital with with the mother... but not for the mother's hospital stay? Have I understood wrong? Does that mean I will be paying for the entirety of my hospital stay after giving birth?

Does anyone have any input/insight/experience on how health insurance companies go about this?
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Old 16.11.2011, 23:01
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Re: Does my insurance cover hospital stay when I give birth?

This will vary depending on the level of cover you actually have. I recommend you contact the health fund direct and ask them the questions, if they are large enough they will likely have someone who speaks decent english. Alternatively if they dont find a fluent speaker of the language and have them make the call for you while you are there.

Also many health insurers provided english versions of policy information on their websites for download.

The wording you have included suggests you are both covered however I would actually check with the insurer rather then relying on interpretations of only 1 section of the policy that you copied.
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Old 16.11.2011, 23:03
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Re: Does my insurance cover hospital stay when I give birth?

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Die Assura übernimmt neben den Kosten für die gleichen Leistungen wie bei Krankheit: a.b.c.d.e.
This is the relevant bit as I see it.
The Assura will take over in addition to the same payments as in the case of illness: a.b.c.d.e.
So if they would pay for your hospital costs in the case of illness (more or less, depending on your specific insurance) they will also pay for this.
I've never heard of anyone not being insured for hospital costs at all. Perhaps the person went into a 'private hospital' not covered by her sickness insurance or went into a 'higher class' of hospital room.

I'd give the office a ring though and make sure if you are so uncertain.
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Old 16.11.2011, 23:09
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Hi,

I had only basic cover with Assura when I had my son in a public hospital and all was covered (including c-section and up to I think 7 days stay afterwards, though I chose to go home after 4).

The point e means that a healthy baby is covered so long as they are staying together with you (i.e so long as you are also still in hospital) but if you haven't already you should sort out insurance for the baby before the birth - in cases of complications etc. the baby is not covered by your insurance alone. It's easy to do, you can arrange a pre-natal contract that will come into effect when the baby is born - contact forum member Jenny for help, she was marvellous when I called on her!
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Old 16.11.2011, 23:17
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I should add of course, if you only have basic cover (not semi-private or private) then you are usually only covered for the public ward / shared room (not a private or 2 bed room). Maybe this is where your friend had the problem? Did she perhaps stay in a (semi-)private room or hospital but with only basic insurance cover? My (non-expert) understanding is that basic cover, regardless of provider, has to cover you for the public ward, in a recognised public hospital in your Kanton of residence.
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Old 16.11.2011, 23:32
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Re: Does my insurance cover hospital stay when I give birth?

From what I understand from a friend who gave birth in Geneva and had semi private. She could "upgrade" to a private room and there she had to pay the difference, which is what she chose to do. Could this it too? She paid for a room category she was not insured for?
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Old 17.11.2011, 11:19
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Re: Does my insurance cover hospital stay when I give birth?

I tried calling my insurance but the person I needed to speak to wasn't available... will try again another time.

Anyway, thanks for all the feedback. I'm covered only with Basic insurance, no private or extras. The clinic I'll be going to in Bern, Klinik Engeried, isn't the canton hospital... I think it's either private or semi-private... and the same one my friend went to as it happens, which is why I'm particularly concerned. The reason I'm going there rather than the Frauenklinik at Inselspital is really a combination of things. My Ob-Gyn is attached to Klinik Engeried, so in a way, even though I could still have chosen the Frauenklinik, it was kinda the "default" hospital I was going to. I was at the Insel Frauenklinik once, for my first ultrasound, and the place just didn't feel very welcoming, all dark corners and cold hallways. On the other hand, I've only heard good things about Engeried from other people who have been there, obviously because they're semi-private, the service is nicer, the place was bright and the staff always smiling, we also had an unplanned tour of the bedrooms and birthing rooms during my pregnancy course, all were very comfortable.

I spoke to my friend again, and according to her, she stayed 7 days instead of the standard 5 days, in a 4-bed room, no upgrade, and her bill came to a little over chf1500. I don't know much about hospital costs, but that sounded relatively reasonable to me, do correct me if this is actually outrageously expensive. Unfortunately if it's not covered by the maternity clause in my insurance and I have to take on the cost myself, it's also less than my deductible. Too bad. I will wait to speak to my insurance again.
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Old 17.11.2011, 16:22
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Re: Does my insurance cover hospital stay when I give birth?

Just a quick update. I've managed to call the insurance company and spoken to someone knowledgeable. They have all my info and also registration information on which hospital I will be giving birth at. They say that so long as i stay in a shared room, i.e. not private or semi-private, then it's all paid for. I'm now really curious what happened with my friend... *shrugs* With my insurance company I have to pay first and get reimbursed later anyway... so at the beginning I'll still have to fork out the hospital fees from my own pockets. hehe.... But this is really comforting news, another weight off my shoulders.

ps. baby insurance was sorted out months ago too

All that's left is after-birth registration paperwork for birth certificates etc, which is rather complicated for non-EU foreigners on B-permits. But all my necessary documents are also ready. Bring it on!!!
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Old 17.11.2011, 16:36
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Re: Does my insurance cover hospital stay when I give birth?

You may find with the question of paying up front versus having the insurance pay. If you can convince the hospital and provide evidence the fund will pay then you can manage the process much better.

We had a situation with a hospital (not a child birth) where the hospital insisted we pay a large sum however we stood our ground and insisted the hospital and insurance talk and sort it out. We then only had to pay our share to the insurance company later.

The only challenge ended up being making sure the hospital admin and insurance company sorted it out, so if you start by having a guarantee of payment letter you may save your bank account cashflow.
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Old 17.11.2011, 16:38
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Re: Does my insurance cover hospital stay when I give birth?

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With my insurance company I have to pay first and get reimbursed later anyway... so at the beginning I'll still have to fork out the hospital fees from my own pockets.
I'm also with Assura, but have always found that for big things like hospital stays, and operations, the hospital bills Assura directly, then if I have to pay something towards it Assura then send me a bill.

For childbirth, it is dealt with separately from your franchise anyway, so hopefully you won't even see a bill
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Old 17.11.2011, 16:46
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Re: Does my insurance cover hospital stay when I give birth?

Nice! Maybe I won't see the bill!
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Old 17.11.2011, 17:20
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Re: Does my insurance cover hospital stay when I give birth?

Sorry, but if your friend was just billed 1500CHF then her hospital stay was absolutely covered. What might not have been covered was the 2 extra non-standard days. But even then, the 1500CHF bill could have been for any number of small things that weren't covered that then added up. But is she thinks her "hospital wasn't covered". She mistaken or she means the extra 2 days weren't covered.

Anyway, when you called did you specific you the hospital you want to deliver in? And double check at that hospital they have something other than private & semi-priviate. They might not.

Good luck!
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Old 17.11.2011, 17:58
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Re: Does my insurance cover hospital stay when I give birth?

Well, when I called my insurance, i gave them my policy number, and said I had questions about my pregnancy and what was or wasn't covered, mainly regarding my hospital stay. They then told me that they had in my records that I was giving birth at the Engeried, which was my hospital of choice.

Of course they'd know, because when I told them i was pregnant, they sent me a form to fill in for details, like expected due date, whether or not I knew the sex of the baby, and also which hospital I intended to go to. And about a month ago, the hospital sent me forms too, because my ob-gyn had notified them of my upcoming due date. That form also asked for details of my due date etc, partner details, as well as insurance details.

They said everything has been prepared and it's all registered and in their system, and that it would be covered, so long as I stay in their shared ward, instead of a private room, so I didn't have to worry about anything except having a safe birth (nice lady ). We were taken on a short tour of the hospital a few weeks ago, so I know that the hospital has 3 different kinds of rooms... 4-bed shared rooms, 2-bed semi-private rooms and single bed private rooms. And in the form they sent me, it stated that I would be staying in their standard room, which when I looked on their website, meant rooms for general patients with basic insurance coverage, with 3 or more beds. I'm assuming that's covered, but in any case I can probably still clear it up when I get there if it's not what I think it is. I can tell them I want the cheapest room with the most beds...

and Minimia, I thought about it, and I think you're right, that my friend was probably charged for the extra days she stayed. She was actually ready to checkout after 4 days but then got an infection, and had to stay longer for it to be treated.
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Old 17.11.2011, 22:05
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Re: Does my insurance cover hospital stay when I give birth?

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and Minimia, I thought about it, and I think you're right, that my friend was probably charged for the extra days she stayed. She was actually ready to checkout after 4 days but then got an infection, and had to stay longer for it to be treated.
Well, if there was a reason she stayed like an infection there is not reason why this shouldn't be covered. Really without seeing her bill we can't know what she ended up paying. The only thing we can say is that if her hospital stay wasn't covered it would have been a lot more than 1500CHF.

Anyway, I'm glad you called and asked about it. If you are feeling worried at all, you could call again and ask if there is anything specific that isn't covered and that you might have to cover yourself.
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Old 17.11.2011, 22:29
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Re: Does my insurance cover hospital stay when I give birth?

What I'm guessing is that perhaps the infection that needed treating was not pregnancy related and therefore has to be tacked onto her deductible instead of being taken on by the insurance as pregnancy costs.

In any case I discussed with hubby and we decided that while it's good news that my hospital stay will be paid for, it would be best just to be prepared that we may have to pay for something extra... then it won't be such a shock to receive a bill later on. Usually it will say on the bill what we're being charged for... and if the insurance wasn't paying for it, they also always state the reason. It doesn't bother me too much at this point. I'm too distracted by other things! Like mini-me coming soon
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Old 18.11.2011, 08:14
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Re: Does my insurance cover hospital stay when I give birth?

Congrats on your pregnancy Bell! I'm due in 2 weeks myself!

Glad you got things sorted out with the insurance company. Definitely best to just be prepared to pay out of pocket - especially if you become uncomfortable with room sharing and want a private room. Have you checked with the hospital to see what the daily cost of that would be? Although I think it would be really nice to share a room, I was warned by my midwife that depending on my condition afterwards, I may hate it due to extra ins and outs by staff and other babies crying etc if I'm exhausted. It would just be really important to take care of Mommy's health & sanity first!

Also regarding your friend, I'd imagine the infection would somehow be pregnancy related and maybe she could dispute the charge? I mean, if I got sick after birth, I could see it being strongly linked to the birth itself - exhaustion, stitches, dehydration, stress, etc...anyways, it's not a huge amount and what matters is that she's well now.

Good luck with a smooth and safe delivery and have an exciting time falling in love with your sweet baby!
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Old 18.11.2011, 23:30
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Re: Does my insurance cover hospital stay when I give birth?

Thanks musings, good luck to you too!

and as far as exhaustion and crying babies go.. I'll deal with that when I get to it.
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