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Old 27.03.2021, 21:44
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Insurance company not paying 2015 bill

Back in 2015 my wife was insured by Advisor Swiss (https://www.advisor-swiss.com/) as she was a student at a uni and this company offered very good rates for students on health insurance. At the end of the year she gave birth to our first son and at the time we had a few issues trying to sort the payment out, but in the end understood that everything was sorted out.

Roll on this week, and weíve received a letter from the hospital saying they still havenít been paid for the birth related costs (chf 8,500) and that we now need to pay them and sort out getting the money back from the insurance ourselves.

Based on some other posts Iíve seen here, as well as other website this insurance company seems dodgy as hell, so I am surprised they can even operate in Switzerland.

Unfortunately the company we have legal insurance with werenít covering us back in 2015 so have said they canít help us. I assume we are going to have to pay privately for a lawyer, but can anyone give any advice on the best course of action here? Many thanks in advance
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Old 27.03.2021, 21:48
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Re: Insurance company not paying 2015 bill

I'm not fully sure, but I think that medical bills expire are 5 years, meaning that you wouldn't need to pay.
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Old 27.03.2021, 21:52
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Re: Insurance company not paying 2015 bill

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I'm not fully sure, but I think that medical bills expire are 5 years, meaning that you wouldn't need to pay.
Surely that would be if the hospital hadn't sent the bill within 5 years.

Maybe you can contact the FOPH?? https://www.bag.admin.ch/bag/en/home...-aufsicht.html
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Old 27.03.2021, 23:14
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Re: Insurance company not paying 2015 bill

The company cited does not seem to offer health insurance. Was it a product that is no longer available or was it travel insurance?

Have you contacted company and asked them why they have not paid? Are you sure birth was covered (as in at all or perhaps was there a waiting period?)

K
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Old 27.03.2021, 23:19
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Re: Insurance company not paying 2015 bill

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The company cited does not seem to offer health insurance. Was it a product that is no longer available or was it travel insurance?
They do student health insurance, which says they cover full child birth costs https://www.assurance-etudiant.ch/en...ational-cover/
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Old 27.03.2021, 23:22
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Re: Insurance company not paying 2015 bill

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They do student health insurance, which says they cover full child birth costs https://www.assurance-etudiant.ch/en...ational-cover/
Sorry you are right, had not seen it under private customer, was nestled in solutions which was not intuitive to me.
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Old 27.03.2021, 23:34
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Re: Insurance company not paying 2015 bill

OP. I would call them and tell them if they don't pay immediately you'll contact the regulator. Also email FOPH and ask for advice. Don't pay anything yourself.
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Old 28.03.2021, 08:28
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Re: Insurance company not paying 2015 bill

Is this the first you have heard from the hospital that the bill has not been paid? We are talking over 5 years ago...

Unless a birth is covered 100% by the insurance company, surely you would have received a statement from the insurance for your share of the costs.
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Old 28.03.2021, 08:58
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Re: Insurance company not paying 2015 bill

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Are you sure birth was covered (as in at all or perhaps was there a waiting period?)
Birth is always covered, with no waiting period (only supplementary has a waiting period).

Any hospital stuff goes direct to the insurer, so this is all odd.

Tom
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Old 28.03.2021, 09:06
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Re: Insurance company not paying 2015 bill

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Birth is always covered, with no waiting period (only supplementary has a waiting period).

Any hospital stuff goes direct to the insurer, so this is all odd.

Tom
I agree that it is odd. OP what is not covered?

Only thing I could think about is that this is NICU or other neonatal stuff related to the baby which is covered by the baby insurance if I am not wrong?
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Old 28.03.2021, 09:33
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Re: Insurance company not paying 2015 bill

Have you actually contacted the health insurance?

I would also ask the hospital for full details (when did they send the bill to the insurance company, has the insurance company refused payment or just aren't responding or are there any outstanding queries etc). Often you don't get the full story up front, they just give the simple "you must pay it now" version.

Then maybe the health insurance ombudsman:

https://www.ch.ch/en/ombudsman-service/

I would have thought (with no evidence...) that if health insurance has a statutory claim limit of five years to send in the bill, then the hospital must take responsibility for that and can't just forget and then send you the bill instead.
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Old 28.03.2021, 09:58
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Is this the first you have heard from the hospital that the bill has not been paid? We are talking over 5 years ago...

Unless a birth is covered 100% by the insurance company, surely you would have received a statement from the insurance for your share of the costs.
This is the first weíve heard from the hospital that the bill hasnít been paid, we have heard nothing from the hospital or insurance company until now

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I agree that it is odd. OP what is not covered?

Only thing I could think about is that this is NICU or other neonatal stuff related to the baby which is covered by the baby insurance if I am not wrong?
As far as we are aware, everything should be covered. It just hasnít been paid

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Have you actually contacted the health insurance?

I would also ask the hospital for full details (when did they send the bill to the insurance company, has the insurance company refused payment or just aren't responding or are there any outstanding queries etc). Often you don't get the full story up front, they just give the simple "you must pay it now" version.

Then maybe the health insurance ombudsman:

https://www.ch.ch/en/ombudsman-service/

I would have thought (with no evidence...) that if health insurance has a statutory claim limit of five years to send in the bill, then the hospital must take responsibility for that and can't just forget and then send you the bill instead.
At this point I donít have the full history of what the hospital has done in order to recoup the costs, only that theyíve tried multiple times. Thanks for the advice though, Iíll follow-up with them

Last edited by 3Wishes; 31.03.2021 at 17:44. Reason: merging consecutive replies
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Old 28.03.2021, 13:17
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Re: Insurance company not paying 2015 bill

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Any hospital stuff goes direct to the insurer, so this is all odd.

Tom
Probably the hospital is aware (certainly they are) and are trying it on with OP. "nothing ventured nothing gained", their cost to give it a shot is minimal.
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Old 28.03.2021, 17:39
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Re: Insurance company not paying 2015 bill

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As far as we are aware, everything should be covered. It just hasnít been paid
Which insurance did your baby have when it was born? Same as the mother or a different one? Treatment for the baby are typically covered by the baby insurance and not the mom so perhaps look into this?

Again I think best call the insurance and get to understand why they are refusing the payment.
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Old 28.03.2021, 20:56
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Re: Insurance company not paying 2015 bill

Was the baby natural birth or c-section? If the baby is fine with natural without any issue but your wife chose c-section then insurance wont cover that.
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Old 28.03.2021, 21:07
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Re: Insurance company not paying 2015 bill

Are you sure it's not a scam and the bill came from the hospital? After 5 years I'd very much put the onus on the hospital to explain why it's due and what it's for. If they've waited 5 years they can wait some more. Possibly an accounting error but who's to know? I wouldn't pay anything until I was sure that the costs were real and really hadn't been paid already.
If you pay now, claiming the money back might be a big problem. Why should the insurer pay you when they didn't pay the hospital? Also I think you only have two years to make claims for reimbursement from the insurer in normal circumstances.
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Old 28.03.2021, 22:01
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Re: Insurance company not paying 2015 bill

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I think you only have two years to make claims for reimbursement from the insurer in normal circumstances.
Five, not two.

Tom
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Old 28.03.2021, 22:15
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Re: Insurance company not paying 2015 bill

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Five, not two.

Tom
Itís two for supplementary insurance which I donít think is applicable here.
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Old 28.03.2021, 22:25
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Re: Insurance company not paying 2015 bill

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Five, not two.

Tom
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Itís two for supplementary insurance which I donít think is applicable here.
Absolutely correct. My mistake.
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Old 30.03.2021, 22:23
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Re: Insurance company not paying 2015 bill

So OP what did the insurance say?
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