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Old 19.03.2012, 11:54
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Excluded treatments and franchise?

Question for those who understand the sysytem better than I...

The doc wants to me to have an MRI done at a center that is out of my canton - therefore the cost is not covered by insurance.

Do any of you know - although the treatment is excluded from my coverage, would what I pay for this nonetheless count towards my yearly franchise, or are excluded/self-paid treatments simply outside the system altogether?

Many thanks.
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Old 19.03.2012, 13:19
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Re: Excluded treatments and franchise?

I had an MRI done outside of the canton (in GE and I lived in VD FWIW) because it was closer to work and it just came out of my franchise. This was in 2007 though.
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Old 19.03.2012, 13:38
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Actually, it should be covered on your insurance minus franchise. As of the start of 2012, you can receive care outside your kanton, so MRI should be covered. If the cost is much higher than it would be in your kanton you may have to pay the difference. But that's not a definite.

As an example, I now live in ZH but my oncologist is in BE. And I have only the "grundversicherung".

Either way, am fairly sure it applies to your franchise.

Your doctor should write a letter to the insurance detailing why you need the MRI and why the particular facility.
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Old 19.03.2012, 13:43
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Re: Excluded treatments and franchise?

Edot, doesn't the new rule only apply to hospital treatment?
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Old 19.03.2012, 13:55
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No, outpatient too, as far as I understand it. My insurer (innova) verified that they would continue to cover my oncology visits.

I also think that if your doc insists you go to a particular place, it would help too.
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Old 19.03.2012, 14:39
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Re: Excluded treatments and franchise?

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...
The doc wants to me to have an MRI done at a center that is out of my canton - therefore the cost is not covered by insurance. ...
Perhaps a silly question, but you have verified this with your insurer?
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Old 19.03.2012, 14:49
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Re: Excluded treatments and franchise?

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Perhaps a silly question, but you have verified this with your insurer?
Not a silly question at all - but I've been trying for a couple of weeks to get through to them, without luck. So I though I'd try asking here.

(So far all out of canton ambulant treatment has been excluded, but since it hasn't been too expensive I haven't worried. Now that we are getting into the big bucks, though, I need to understand the finances a bit better.)
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Old 19.03.2012, 17:05
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Re: Excluded treatments and franchise?

I had out of canton tests last year that were covered. I did ask my insurer first; they said

You have the insurance model STANDARD with SWICA. An out-patient treatment at <hospital in other canton> with <out of canton doctor> is covered through your policy (regarding the cost-sharing). If an inpatient treatment should be necessary we recommend to get in touch with us first.


Obviously, it's not definitive for you, but it seems likely that you'll be covered. Hope so.
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Old 19.03.2012, 17:17
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Re: Excluded treatments and franchise?

I have a question about insurance as well - regarding treatment from an accident vs. an illness. I have heard contradictory opinions if insurance will cover costs associated with an accident without need to first pay the deductible (franchise), that they wouldn't cover as an illness until after the deductible is paid. Does anyone here have experience with this?

I had an MRI done about 6 weeks ago but haven't gotten a bill yet...but have been billed for some of my dr. consultations from the accident. Anyhow, I sent in what bills I have last week to the insurance so I will find out sooner or later from them, but I thought I would see what the general consensus is here!

ps - what does an MRI cost here?
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Old 19.03.2012, 19:56
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Meloncollie: it might be worthwhile for your doc to write a letter to your insurer, detailing what was prescribed, just so you know that you have verification of coverage. Or is that what you're waiting to hear about from your insurer?

I am pretty sure that if you need a particular treatment or procedure that's not available in your kanton, insurers will cover it in another kanton if it's deemed necessary.

Drmom: I can't quite figure out the accident vs sickness stuff. My husband had a sledding accident and went to emergency. We sent the stuff to his insurance and they sent him a bunch of forms to fill out. The bill was about chf 300, so I just paid it and he never sent in the forms for the accident stuff. I don't believe it was applied to his deductable though.

I've never had an MRI so have no idea of the cost. Most stuff is less expensive than in the US, other than prescription drugs. I guess it also depends on the MRI - how extensive, the contrast medium. I had a full body bone scan with radioactive material, that was about chf 700.

Last edited by edot; 19.03.2012 at 21:13.
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Old 20.03.2012, 09:49
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Re: Excluded treatments and franchise?

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Drmom: I can't quite figure out the accident vs sickness stuff. My husband had a sledding accident and went to emergency. We sent the stuff to his insurance and they sent him a bunch of forms to fill out. The bill was about chf 300, so I just paid it and he never sent in the forms for the accident stuff. I don't believe it was applied to his deductable though.

I've never had an MRI so have no idea of the cost. Most stuff is less expensive than in the US, other than prescription drugs. I guess it also depends on the MRI - how extensive, the contrast medium. I had a full body bone scan with radioactive material, that was about chf 700.
Thanks!

I just had a partial one done on my knee, so I guess it should be less than the 700 for yours, good to know! I will just wait and see what the insurance company says, hopefully it won't take too long to find out, I think I sent the stuff in a week ago and usually things are handled quite quickly here. I could call and find out, but that would spoil the suspense Of course, I have the 2500 deductible, so it could be an expensive health year if they don't pay. Oh well, what can you do?
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Old 20.03.2012, 09:51
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Re: Excluded treatments and franchise?

I did an MRI 1 month ago, I did it in France total cost 130 euro!!!!!!!!!! It would have cost 900 in the UK.
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Old 20.03.2012, 11:51
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Re: Excluded treatments and franchise?

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I have a question about insurance as well - regarding treatment from an accident vs. an illness. I have heard contradictory opinions if insurance will cover costs associated with an accident without need to first pay the deductible (franchise), that they wouldn't cover as an illness until after the deductible is paid. Does anyone here have experience with this?

I had an MRI done about 6 weeks ago but haven't gotten a bill yet...but have been billed for some of my dr. consultations from the accident. Anyhow, I sent in what bills I have last week to the insurance so I will find out sooner or later from them, but I thought I would see what the general consensus is here!

ps - what does an MRI cost here?
You'll need to fill in a declaration form if you're claiming on your accident insurance, your insurance will in theory send you one in response to you're having already sent them bills; if it's clear that they're for an accident, did you point that out to them?
Accident insurance doesn't normally have a franchise, so it's worth doing!

As for the cost of an MRI, depends on which bit you're having done..... a torso MRI is more expensive than one done on your foot for example!
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Old 20.03.2012, 12:30
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Re: Excluded treatments and franchise?

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You'll need to fill in a declaration form if you're claiming on your accident insurance, your insurance will in theory send you one in response to you're having already sent them bills; if it's clear that they're for an accident, did you point that out to them?
Accident insurance doesn't normally have a franchise, so it's worth doing!

As for the cost of an MRI, depends on which bit you're having done..... a torso MRI is more expensive than one done on your foot for example!
I called them within a week of the accident telling them about it. They in turn sent me a form to fill out with all the info. Since then, I haven't heard anything, so I figured I would send them in the bills...

I did also write on the paperwork with the bills my "Police" number and that it was for an "Unfall" as was indicated in the instructions for sending in bills. I hope that it will be covered without the franchise - it'll be easier to convince OH that I deserve that new iPad
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Old 20.03.2012, 13:18
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Re: Excluded treatments and franchise?

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ps - what does an MRI cost here?
The quote I got from the MRI center was for a head-only MRI: ca. CHF 2500-3000.

I don't know if that is all-inclusive, or if there would be additional consulation fees from the imaging center on top of that. Certainly the referring doctor's consultation would be additional.

(These prices are similar to what I would pay in the US.)


ETA: Fatmanfilms, looks like a trip to France is in the offing...
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Old 20.03.2012, 13:23
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I've had 3 MRI's, two on my head and one one my back - all from the same MRI centre in Zurich. Each one cost 950 CHF.
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Old 20.03.2012, 13:26
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Re: Excluded treatments and franchise?

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I've had 3 MRI's, two on my head and one one my back - all from the same MRI centre in Zurich. Each one cost 950 CHF.
JanerMacP, may I ask which MRI center that was? That's quite a price difference - I think I need to do some comparison shopping!
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Old 20.03.2012, 13:28
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Sure! - MRI Bahnhofplatz
+41 44 225 2090
www.mri-roentgen.ch
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Old 20.03.2012, 13:41
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Re: Excluded treatments and franchise?

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The doc wants to me to have an MRI done at a center that is out of my canton - therefore the cost is not covered by insurance.
Just to cover all bases, I assume you do not have any supplemental insurance? While basic insurance can be difficult on out of canton treatment, it is one of the perks often covered by supplemental insurance in my experience.
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Old 20.03.2012, 14:18
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Re: Excluded treatments and franchise?

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JanerMacP, may I ask which MRI center that was? That's quite a price difference - I think I need to do some comparison shopping!
They can charge whatever the insurance will pay, the kit is expensive but it's a real money spinner in most places around the world.
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