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Old 09.10.2012, 15:14
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Swisscare costs for private clinic

Does anyone happen to know about the costs for an operation in a private hospital with Swisscare? I have an operation coming soon due to a condition called endometriosis, for which I need the treatment of an expert only found in the private sphere. I have tried to ask about the costs, without success, from the insurance company, from the hospital and the doctor himself. The latter told me it should be around 5000chf but was not very precise with his estimation. Now they want me to pay this 5000chf at the arrival to the hospital and won't give me any answer about whether I will need to pay more afterwards. Please, any help would be appreciated!
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Old 09.10.2012, 15:29
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Re: Swisscare costs for private clinic

I wouldn't guess that Swisscare is the easiest insurance company to make more complicated claims. But if the condition was diagnosed or existent before you joined Swisscare, your chances will be very slim to get that money reimbursed.
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Old 09.10.2012, 15:39
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Re: Swisscare costs for private clinic

Thanks for the reply! The final costs will probably be a lot more than 5000chf. What I understood from the doctor's reply was that 5000chf will be for me to pay and the insurance will cover the rest. My only worry now is whether the costs for me will eventually be more than that.
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Old 09.10.2012, 15:43
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Re: Swisscare costs for private clinic

It depends on which type of insurance you have, and if it covers private clinics.

Tom
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Old 09.10.2012, 15:57
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Re: Swisscare costs for private clinic

Endometriosis is a relatively common condition. I would not automatically assume you can only receive surgery for it at a private hospital. It should not be considered elective surgery either - and thus should fall within your normal insurance's scope - with appropriate co-payment up to your limit (at a public hospital). I highly recommend you make a few more calls before forking over that kind of money. Good luck and hope you feel better soon.
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Old 09.10.2012, 16:20
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Re: Swisscare costs for private clinic

Thanks for the quick replies!! Endometriosis is indeed quite common but mine happens to be of a very difficult type. In the past I have been treated in the public sphere in Finland with no particular expertise on endo and the results were bad. In Lausanne area, the only expertise that I could find was clinic Cecil with doctor Jaques Dequesne which I believe to be a private practician. But thanks for the tip, I will check out once more, if there are any other doctors knowing anything about endometriosis in Lausanne area. Otherwise, I'd rather pay for this sum for my health. If only I could be sure that it will not be more...
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Old 17.10.2012, 16:34
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Re: Swisscare costs for private clinic

Well the hospital should be able to give you a cost estimate - insurances usually can't. Then the question remains if the clinique is a basic provider and is allowed to offer services in accordance to the Swiss health insurance law.

Regards

Carolina
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Old 18.10.2012, 21:49
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Re: Swisscare costs for private clinic

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Thanks for the reply! The final costs will probably be a lot more than 5000chf. What I understood from the doctor's reply was that 5000chf will be for me to pay and the insurance will cover the rest. My only worry now is whether the costs for me will eventually be more than that.
You should insist: your doctor must be able to tell you if the surgery you need is covered by your basic insurance! Ask the clinique Cecil for a brochure with the roomlist and the corresponding prices. Here is the homepage: http://www.hirslanden.ch/
global/fr/accueil/cliniques_centres/clinique_cecil/portrait/hotellerie_et_services/
chambres.html

Afaik, a private clinic is very good (some say even better than a public hospital) for such surgeries. The Cecil clinic belongs to the Hirslanden group, that I can recommend! Their prices are high, but the lack of transparency bothers me more. You will be in good hands - parane pian (I hope this is correct )
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Old 18.10.2012, 22:15
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Re: Swisscare costs for private clinic

I would have thought that your medical problem could be quite competently handled by the CHUV in Lausanne, and the costs covered (perhaps not entirely), by your insurance company.

I would NOT recommend the Clinique Cecil - I speak from personal experience!
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Old 18.10.2012, 22:22
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Re: Swisscare costs for private clinic

I think you perhaps need to consider that using a public hospital in Finland with a doctor who had no 'specialist' expertise, is very different to going to a big teaching hospital in Switzerland where specialists abound.

Surely your gynaecologist can recommend you several names of doctors who specialise and work in your area, or book you in to see the head doctor/specialist for gynaecology in the biggest local hospital you can find...

Having had a friend who went in for a 40 minute exploratory surgery for endometriosis and went out after 4 hours surgery and a 10 day stay in hospital...I'd be considering plenty of 'what ifs'. Like most others have said, there should be absolute transparency about the cost, and you should go into the operation 100% sure that it will be covered by your health insurance...
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Old 18.10.2012, 22:31
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Re: Swisscare costs for private clinic

Found you the relevant department at the CHUV Lausanne.
http://www.chuv.ch/dgo/dgo_home/umr/...dometriose.htm
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Old 18.10.2012, 22:34
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Re: Swisscare costs for private clinic

Sorry, I have no experience of your particular condition. But if I had the choice between specialists at the CHUV, or a private Clinic, I'd choose the CHUV everytime, irrespective of cost (but which would save you lots of money).
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Old 18.10.2012, 22:39
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Re: Swisscare costs for private clinic

I was under the impression that pre-existing conditions cannot be excluded from basic insurance, so any policy would cover it, and merely an upgrade premium applied to full private care ? Even them , I doubt whether private consultants exclude themselves from basic treatment ?

More research needed.
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Old 18.10.2012, 22:50
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Re: Swisscare costs for private clinic

Pre-existing conditions are definitely excluded from private treatment, I'm afraid.
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Old 19.10.2012, 08:39
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Re: Swisscare costs for private clinic

Pre exisiting conditions are usually excluded in the General Insurance Conditions of private insurances. However they can not be excluded by insurance that offer coverage in accordance with LaMal/KVG.
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Old 19.10.2012, 09:30
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Re: Swisscare costs for private clinic

Quote:
Pre-existing conditions are definitely excluded from private treatment, I'm afraid.
That would be policy / insurer specific wouldn't it ? Basic coverage is covered by legislation, so not sure how you can confidently say this about all private policies. I have had two existing conditions treated under a private policy myself.
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Old 19.10.2012, 10:15
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Re: Swisscare costs for private clinic

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That would be policy / insurer specific wouldn't it ? Basic coverage is covered by legislation, so not sure how you can confidently say this about all private policies. I have had two existing conditions treated under a private policy myself.
YEs, treatment is covered - but if treated in a hospital, one might not be able to choose the physician under basic insurance. According to comparis:

Allgemeine Abteilung ganze Schweiz: Anspruch auf Behandlung auf der allgemeinen Abteilung auch in Spitälern ausserhalb des Wohnkantons. Aus der obligatorischen Grundversicherung werden nur die Kosten für die Behandlung auf der allgemeinen Abteilung im Wohnkanton bezahlt.

Halbprivate Abteilung ganze Schweiz: Anspruch auf Bezahlung eines Zweibettzimmers und in der Regel auf Behandlung durch den Oberarzt.

Private Abteilung ganze Schweiz: Anspruch auf Bezahlung eines Einbettzimmers und in der Regel auf Behandlung durch den Chefarzt.


From what others have posted on various threads this does not always seem to be adhered to - but it certainly has been in my experience. I was not able to see the 'expert' in my condition under basic insurance, only junior staff.

So if the OP doesn't have supplementary insurance, there is indeed a chance that she will need to pay privately if she wishes to see a specific doctor who normally does not take patients with only basic insurance. However, if her Hausarzt has made a referral to a specific doctor, not just to the hospital clinic... chances are that the basic insurance might cover it.

As always, check with the insurer before treatment to avoid surprises.
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Old 28.07.2020, 19:11
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Re: Swisscare costs for private clinic

Hi Verna. Found your post while looking for a similar information. I hope you had a good experience back then with your operation. I also have endometriosis and require regular medical exams. Just moved to Switzerland (Bern) and purchased a Swisscare insurance for international students. I was wondering if Swisscare covers the cost of endometriosis treatment (also in my case it has been pre-existing). Hope this text will still reach you, or maybe somebody else know. All the best!
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