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Old 13.07.2017, 23:28
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Disputing a Health insurance invoice

Hi,

I am hoping someone here can help me in trying to resolve an invoice problem from our health insurance company.

My wife gave birth to a baby boy at the end of 2016 in Zurich. All went well and the medical care we received at the hospital was excellent. However, a few months ago we received a rather large invoice from our insurance company to cover the cost of her hospital stay. We queried this with both the insurance company and the hospital and received a copy of the itimised bill that the hospital sent to the insurance company.

It appears that the hospital charged our insurance company for procedures that were not performed and for items that should have been covered under the basic insurance model.

The health insurance have already paid the hospital and now are invoicing us for around 80% of what they paid. Insurance are basically saying it's not their problem and we still have to pay them and sort it out with the hospital ourselves. The hospital is refusing to answer our questions either by e mail or over the phone. Or we are passed from one administrator to the next who each in turn promise to contact us but never do.

My question is, if there is an overseeing body here in Switzerland or Zurich where the hospital is based that can assist us in getting the hospital to recognise their mistake or at least acknowledge our complaint. As it appears we are caught between an insurance company that just want their invoice paid and a hospital which refuses to deal with us and recognise their error. All while the insurance company add on 20 CHF each month onto the unpaid invoice!
Any advice is appreciated.

Thanks.
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Old 13.07.2017, 23:44
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Re: Disputing a Health insurance invoice

could it be that you had a private/semi-private room but were not insured for it?
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Old 13.07.2017, 23:54
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Re: Disputing a Health insurance invoice

No, she was in a shared room. No different treatment to anyone else and a natural birth without complications. Only 2 nights in the hospital. It's just an administrative error I think on behalf of the hospital. But the hospital won't even explain to us where their costs came from. That's the problem we have. Other than an itimised invoice they have refused to communicate with us.
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Old 14.07.2017, 00:15
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Re: Disputing a Health insurance invoice

I would start with giving SPO patientenschutz a call or visit i think, even if they would not be willing/able to handle this they should be able to guide you in the proper direction.
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Old 14.07.2017, 17:56
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Re: Disputing a Health insurance invoice

What an already stressful time to have to deal with this!

How have you tried to talk to the hospital? Going to see them in person with your documentation strikes me as the best chance to get somewhere.

If you are doing it by letter, then it must be registered, and provide an expectation to hear back within one month.
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Old 14.07.2017, 20:31
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Re: Disputing a Health insurance invoice

Most private hospitals in Switzerland do not have general wards. In case you went to a private hospital, you may end up paying a big invoice. Hope you had pre checked with your insurer prior to admission in the hospital
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Old 14.07.2017, 20:33
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Re: Disputing a Health insurance invoice

I don't see any particular reason to assume that the hospital is innocent of the charges (so to speak). It's not like hospitals don't overcharge/double charge/ incorrectly charge in Switzerland.
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Old 14.07.2017, 20:51
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Re: Disputing a Health insurance invoice

Could it be that you have Allgemein insurance and the hospital is a private hospital?

That could explain it....
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Old 14.07.2017, 21:21
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Re: Disputing a Health insurance invoice

Ombudstelle Krankenversicherung:

https://www.om-kv.ch

You might try contacting this organization. Be aware that they are on holiday 22 July through 6 August.
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Old 14.07.2017, 23:27
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Re: Disputing a Health insurance invoice

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Hi,It appears that the hospital charged our insurance company for procedures that were not performed and for items that should have been covered under the basic insurance model.

I am puzzled by this statement. Can you give examples? How do you know for sure they were not 'performed' as such.
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Old 15.07.2017, 01:35
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Re: Disputing a Health insurance invoice

It is actually very rare for a hospital to make an error as everything is coded (Tarmed) so that accountability is ensured. I am not saying it never happens, but its rare.

I believe there is a health ombudsman.

I dont really understand why the insurance isn't paying 90% after the disclaimer, which is what its lwgally required to do.
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