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Old 18.11.2020, 00:37
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Medicines / drugs provided by your doctor are reimbursed by the insurance?

Hey!

We are a little bit lost here since it's the first time we are in a health scheme like the Swiss one…

The medicines / drugs / or whatever that are provided by your doctor when you go their office are always reimbursed by the insurance —since they are part of the doctor visit—or depends on the medicine / drug?

I mean… the insurance is going to review the doctor invoice and if something is not covered they aren't going to reimburse you, right?

So every time the doctor offers something you should ask if it's gong to be covered by the insurance, shouldn't you? Or how the hell are you going to know then?
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Old 18.11.2020, 01:18
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Re: Medicines / drugs provided by your doctor are reimbursed by the insurance?

https://www.ch.ch/en/basic-health-insurance-services/

Deductible
The deductible (often referred to in Switzerland as the "franchise") is the amount (CHF 300 for adults; children up to the age of 18 do not pay a deductible) that you have to pay towards your treatment costs every year. Only after this amount has been reached does the insurance company start to pay out. If you want to reduce your premium, you are free to increase your deductible.

Retention fee
Even after the deductible has been exceeded, you still have to pay 10 per cent of any treatment costs. However, this charge, often referred to as a "retention fee", amounts to a maximum each year of CHF 700 for adults and CHF 350 for children.

Hospital contribution
The hospital contribution amounts to CHF 15 per day spent at the hospital. Children, young adults in education or training and women whose maternity benefits are fully covered do not pay any hospital contribution.

Avoid unpleasant surprises
When a doctor prescribes treatment that is not covered by the basic insurance, he or she must inform you about it. However, if you have any doubts, it is worth checking with your health insurance company.

Also check with your insurance how they handle reimbursement of generics v original medication. Mine favours the choice of generics unless the original medication name is written on the prescription.
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Old 18.11.2020, 01:41
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Re: Medicines / drugs provided by your doctor are reimbursed by the insurance?

There should be no difference - in terms of the information and cost - whether you get your medication from a doctor or from a pharmacy.

As Sigh said, they are supposed to tell you whether there is a cheaper, generic version of the medication, and whether any part of it will not be covered by the medical insurance. However, I agree that it's a good idea to ask, just to be sure (before they type out the adhesive label with the dosage and stick it to the box).

I prefer to buy medication from a pharmacy, rather than drawing it from the doctor. If you or your family members are likely to have any ongoing need of medication, it can be well worth your while to build a relationship with a pharmacy. They are not just a shop, but they have their regular customers on file. That can be useful if the pharmacy will do the work, on behalf of the patient, of obtaining a repeat prescription directly from the doctor.

My pharmacist once prevented complications when I was prescribed medication by more than one doctor (in different fields). The pharmacist checked those medications against one another, and saw that that combination was no good. As this pharmacy maintains good relationships with the doctors, they phoned those doctors for me, to discuss what to dispense, instead. That really saved me a lot of trouble.
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Old 18.11.2020, 08:05
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Re: Medicines / drugs provided by your doctor are reimbursed by the insurance?

It it’s not on the list the insurance companies are not obliged to pay (or deduct it from your francise). I had one case where my Dr wrote to the insurance and explained why and they agreed to pay (It was later added to the list). I had another case where a scan was not approved for my particular type of cancer. It was approved for others. The clinic had me agree to pay the bill myself, before they would do the scan. It too has been put back on the list for my cancer, but the insurance company wouldn’t pay it retroactively.

This is over 36 years.
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Old 18.11.2020, 08:08
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Re: Medicines / drugs provided by your doctor are reimbursed by the insurance?

I think that the insurance companies should be obliged to pay 100% of the costs of generic drugs. That is, provided there is at least a 10% savings in cost and the franchise has been covered.
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Old 18.11.2020, 16:16
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Re: Medicines / drugs provided by your doctor are reimbursed by the insurance?

I don't know if you have really answer my question. Perhaps I didn't state it correctly.

I was thinking that whatever if given to you on a doctor appointment was going to be reimbursed to you —if you have reached your deductible—because it's a doctor visit.

However, if you go the pharmacy, unless the doctor has prescribed it —and it's on the list— you have to pay drugs / medicines / products from your pocket.

I understand the lingo and about the list of approved drugs and procedures.
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Old 18.11.2020, 17:12
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Re: Medicines / drugs provided by your doctor are reimbursed by the insurance?

You mean if you go to the doctors for something and the doctor hands you some medication which you just as easily could have bought in a pharmacy without prescription, do you have to pay for the medication out of your own pocket or would the insurance pay the entire invoice, and how should you know?



I don't know about that specific situation but there are some common medications that the insurance do not pay for, even if you have a prescription. I had a claim for some ibuprofen refused because it was deemed as something which everybody might need from time to time. The context was not taken into consideration. If I need it now I ask the doc for a larger aount at a higher dose, then it's covered. It also seems to work the other way around. I got refunded for some athlete's foot cream which can be bought without prescription.
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Old 18.11.2020, 17:12
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Re: Medicines / drugs provided by your doctor are reimbursed by the insurance?

If not on approved list, yes. Very rare for a doctor to rpescribe something that is not on the list though- unless you specifically asked for it.


I was prescribed Voltarol Forte for knee pain, but it is not reimbursed. I am not sure, but perhaps the Forte version is not available without prescription (as said, not sure).
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Old 18.11.2020, 19:26
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Re: Medicines / drugs provided by your doctor are reimbursed by the insurance?

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I was thinking that whatever if given to you on a doctor appointment was going to be reimbursed to you —if you have reached your deductible—because it's a doctor visit.

However, if you go the pharmacy, unless the doctor has prescribed it —and it's on the list— you have to pay drugs / medicines / products from your pocket.
You can get medication in these ways:
  1. the doctor gives you the box of medication during the visit,
  2. the doctor gives you a prescription, and you take that to the pharmacy and buy the medication there
  3. you just buy the medication yourself, without any doctor's order (but this works only for basic, plain medications; more serious ones need a prescription).

The medical insurance will reimburse, or will not be reimburse, the cost of the medication according to the rules for that specific medication (and not according to where/how you got it).

1. and 2. above will lead to the identical result from the medical insurance.
3. will be at your expense. You can try to submit it to the medical insurance, but usually they will decline.
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Old 18.11.2020, 20:04
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Re: Medicines / drugs provided by your doctor are reimbursed by the insurance?

My wife's doctor often gives her stuff and prescribes stuff that aren't covered by insurance.

Tom
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Old 18.11.2020, 20:40
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Re: Medicines / drugs provided by your doctor are reimbursed by the insurance?

Re: Meds from the pharmacy - don't forget the Medikamentcheck/Beratungszuschlag.

Anytime the pharmacist advises you ("Have you used this medicine before?") or opens/updates your file, the pharmacy is entitled to charge a fee for that service.

Explanation from Beobachter:

https://www.beobachter.ch/gesundheit...apotheke-einen

---

BTW, the article contains a link to a list of pharmacies that do not charge this fee.

---

Fortunately I get most of my own prescription meds direct from my doctors, and so do not have to pay this fee for those.
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Old 18.11.2020, 20:43
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Re: Medicines / drugs provided by your doctor are reimbursed by the insurance?

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You can get medication in these ways:
  1. the doctor gives you the box of medication during the visit,
  2. the doctor gives you a prescription, and you take that to the pharmacy and buy the medication there
  3. you just buy the medication yourself, without any doctor's order (but this works only for basic, plain medications; more serious ones need a prescription).

The medical insurance will reimburse, or will not be reimburse, the cost of the medication according to the rules for that specific medication (and not according to where/how you got it).

1. and 2. above will lead to the identical result from the medical insurance.
3. will be at your expense. You can try to submit it to the medical insurance, but usually they will decline.
There are also some minor medical issues which can be covered by the pharmacy and paid for by insurance. I have no idea which ones, only speaking from experience having received antibiotic cream for an infected insect bite.
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Old 18.11.2020, 20:48
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Re: Medicines / drugs provided by your doctor are reimbursed by the insurance?

My wife’s knee Dr injects some medicine into her knee to relieve the wear and tear. It is not normally available at pharmacies and it has a short shelf life. He has his own source now, we used to have to get it across the border.

So he sends us a separate bill for that medicine, which we pay and submit to the insurance for reimbursement. Subject to franchise and deductible. He also submits his normal bill to the insurance company directly.
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Old 18.11.2020, 21:17
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Re: Medicines / drugs provided by your doctor are reimbursed by the insurance?

I've not had any problems even while on the basic insurance - so long as the medicine was related to the actual complaint/reason for the visit, and in a reasonable quantity.

If I go in with sniffles or a cold (pre-covid!), then the doctor gives me an extra inhaler, and one box each of sinupret forte and neocitran. All are reimbursed subject to franchise and co-pay. When I went in for a hurt shoulder, I received several days of paracetamol and some voltaren gel to rub in, also reimbursed.

I like that I can get a few meds right at the doctor's when I'm feeling poorly, rather than having to make a separate trip to a pharmacy.
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Old 18.11.2020, 22:31
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Re: Medicines / drugs provided by your doctor are reimbursed by the insurance?

Whenwas that- Voltaren/Voltarol gel is no longer reimbursed (not for me on basic, not for my brother who has multiple complementaries).
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Old 18.11.2020, 22:51
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Re: Medicines / drugs provided by your doctor are reimbursed by the insurance?

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Whenwas that- Voltaren/Voltarol gel is no longer reimbursed (not for me on basic, not for my brother who has multiple complementaries).
It is if you get the right one.
I was in the pharmacy this morning collecting a prescription for OH and got the one reimbursed by basic insurance.
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Old 19.11.2020, 23:05
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Re: Medicines / drugs provided by your doctor are reimbursed by the insurance?

Sorry, I used voltaren as a generic catch-all for anti-inflammatory gel. I have no idea what it really was, it is long since used up. It was given to me by my doc at his clinic, not at the pharmacy.
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Old 19.11.2020, 23:43
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Re: Medicines / drugs provided by your doctor are reimbursed by the insurance?

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Re: Meds from the pharmacy - don't forget the Medikamentcheck/Beratungszuschlag.

Anytime the pharmacist advises you ("Have you used this medicine before?") or opens/updates your file, the pharmacy is entitled to charge a fee for that service.

Explanation from Beobachter:

https://www.beobachter.ch/gesundheit...apotheke-einen

---

BTW, the article contains a link to a list of pharmacies that do not charge this fee.

---

Fortunately I get most of my own prescription meds direct from my doctors, and so do not have to pay this fee for those.
Thank you, that's an interesting article. There is a fee, too, when getting one's medication from a doctor, but it is charged as a part of the overall service the doctor provides.

From that Beobachter article:
Those who obtain their medication directly from the doctor - this is now possible in most cantons - do not pay an additional fee for them. However, the consulting effort is compensated for per unit of time.

Wer seine Medikamente direkt beim Arzt bezieht – das ist mittlerweile in den meisten Kantonen möglich –, zahlt für diese keine zusätzliche Gebühr. Allerdings wird der Beratungsaufwand da pro Zeiteinheit entschädigt.
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Old 20.11.2020, 00:24
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Re: Medicines / drugs provided by your doctor are reimbursed by the insurance?

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Thank you, that's an interesting article. There is a fee, too, when getting one's medication from a doctor, but it is charged as a part of the overall service the doctor provides.
Does your doctor charge you extra time to hand over meds?

Mine doesn't.


My pet peeve - literally - with the Beratungszuschlag at the Apotheke is that the only meds I get at the Apotheke are for the critters.

The pharmacist is not qualified to advise on veterinary use of these meds - she has said so herself. Yet I am still charged the fee, because these meds, if prescribed for a human, fall under the Beratungszuschlag list. But they are not for a human, they are not covered by insurance, so I shouldn't be charged the fee.

I have tried for years to argue this. But 'computer says no...'

Hence I avoid getting meds from an Apotheke whenever there is an alternative.
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Old 20.11.2020, 00:51
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Re: Medicines / drugs provided by your doctor are reimbursed by the insurance?

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I avoid getting meds from an Apotheke whenever there is an alternative.
There are no alternatives in Ticino that are covered by insurance.

Tom
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