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Old 22.05.2012, 14:18
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Re: confused

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You should have paid for the toxoplasma test. It isn't covered by the pregnancy benefits anymore. Or at least I was told that when I went for my first check up.

I'd gather the ultrasound and appointment at 8 weeks wasn't covered because it's a bit early for a first appointment.

The blood test should all be covered

http://www.bag.admin.ch/themen/krank...x.html?lang=en
should i ask about it or better just let it go??
i am afraid that after i demand that they should reimburse the blood test, they will also demand me to return the toxoplasma money which is lot higher. is that possible?
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Old 18.06.2012, 15:22
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Re: confused

UPDATE :
It seems that everything done before week 12 (mine at 8 weeks) will not be reimburse. In my case : appointment, ultrasound, blood test and PAP SMEAR. Eventhough according to the regulation PAP SMEAR and blood test should be cover it wasn't. (at least in my case with EGK).

And I have to paid for my own pockets for 2 appointment. At my first appointment, my Obgyn only did the introduction and ultrasound (240 CHF) and she told me to come again next week (160 CHF) for the PAP Smear and check up (weight, blood pressure measurement, etc).
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  #23  
Old 18.06.2012, 20:34
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Re: confused

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UPDATE :
It seems that everything done before week 12 (mine at 8 weeks) will not be reimburse. In my case : appointment, ultrasound, blood test and PAP SMEAR. Eventhough according to the regulation PAP SMEAR and blood test should be cover it wasn't. (at least in my case with EGK).

And I have to paid for my own pockets for 2 appointment. At my first appointment, my Obgyn only did the introduction and ultrasound (240 CHF) and she told me to come again next week (160 CHF) for the PAP Smear and check up (weight, blood pressure measurement, etc).
From the comparis web site:

5. Additional benefits for maternity
Examinations performed by doctors or midwives or examinations ordered by doctors are covered by basic health insurance during and after pregnancy. Insurers must cover costs for 7 routine examinations (2 of which may be uterus scans, between the 10th and 12th as well as between the 20th a nd 23rd week of pregnancy, more in case of a high-risk pregnancy) and a post-natal examination (6 to 10 weeks after giving birth).
Childbirth either at home, in a general hospital ward in the canton of residence or in a semi-inpatient situation, including preparation and aid provided by doctors or midwives, is covered, as well as:
Up to three breastfeeding consultations

It seems to me that all of your costs, aside from the ultrasound, and apparently, from other posters, the toxoplasmosis screen, should be covered. I would make sure that the tests were deemed necessary by the doctor (i.e. get your doctor to write a short letter saying that the tests are necesssary) and then ask the insurance again. In my experience, unless the doctor says that it is necessary for the reason of pregnancy, the insurance will automatically add it to your yearly deductable. Also, Wife_of_Porsch's reference states the same, and is more thorough.

On a side note, are you on a limited plan (GP/HMO model?) If so, did you follow the rules about seeing a doctor within the plan/making a phone call/whatever other rules they have? I only ask because this seems very weird, and maybe there is something more restrictive about your plan that would explain it.
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  #24  
Old 18.06.2012, 20:58
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Re: confused

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It seems to me that all of your costs, aside from the ultrasound, and apparently, from other posters, the toxoplasmosis screen, should be covered. I would make sure that the tests were deemed necessary by the doctor (i.e. get your doctor to write a short letter saying that the tests are necesssary) and then ask the insurance again. In my experience, unless the doctor says that it is necessary for the reason of pregnancy, the insurance will automatically add it to your yearly deductable. Also, Wife_of_Porsch's reference states the same, and is more thorough.
My Doctor (Obgyn) told me that basic insurance only cover examination starting on week 12 ( i did not find this in the reference) and ultrasound on week 8 will be cover by me. So, on the invoice she mention that this is not a maternity but a disease. And she will not change it. However I should get reimbursement for the blood test and PAP SMear. But EGK refused to reimburse this 2 things. Not only that, EGK also refused to paid the iron supplement. My Obgyn prescript me an Iron supplement for a year. WHen i bought this at the pharmacy, they told me that the insurance will cover it so i didn't need to pay. But a month letter, EGK send me the invoice and told me that they didn't cover it and i need to repay them the money back. Today i went for the second batch of the supplement and once again, i was told that this kind of med will be cover by insurance. They even double check it for me.

I don't know if the problem is with my Obgyn or with the insurance company (EGK).

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On a side note, are you on a limited plan (GP/HMO model?) If so, did you follow the rules about seeing a doctor within the plan/making a phone call/whatever other rules they have? I only ask because this seems very weird, and maybe there is something more restrictive about your plan that would explain it.
My plan is HMO. But in case of maternity i do not need any referral. And i make an appointment 2 weeks before the appointment. So there is nothing wrong with my plan.
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