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-   -   Refused semi-private health insurance (https://www.englishforum.ch/insurance/305079-refused-semi-private-health-insurance.html)

itsjess 21.07.2021 17:09

Refused semi-private health insurance
 
I have been liaising with a representative from SWICA, and I thought I had read all the paperwork comprehensively and understood the conditions and costs.

After submitting my forms however, I've just been told that my preferred option, which included semi-private cover in case of hospitalisation, has been refused due to my 'health situation'.

The only situation I mentioned is that I broke my ankle 5 years ago. The ankle was repaired surgically on the day of the accident, with the insertion of 2 small screws.

This seems like a very minor reason to refuse the preferred coverage, which I'm quite willing to pay for. Has anyone else had a similar experience?

NotAllThere 21.07.2021 17:24

Re: Refused semi-private health insurance
 
Seems a bit odd. I'd always advise going through the forms with the representative, as they'll generally try to get the best deal for you, and what you want. I do know exclusions are possible.

I suggest you have another chat with them.

However, I've been on public insurance with Swica and had major and minor surgery. I've never really seen the point of private/semi-private. There's only ever been one other person in my room.

(Last time I was hospitalised, my room mate was awesome. Once I started to feel better, we just chatted all day. A retired anaethetists. He knew everyone and was massively charming. Given his connections, even I got treated like a human by the doctors!).

bowlie 21.07.2021 17:40

Re: Refused semi-private health insurance
 
Are there wards in any Swiss Hospital? I’ve only see singles and doubles.

Kittster 21.07.2021 17:54

Re: Refused semi-private health insurance
 
Quote:

Originally Posted by bowlie (Post 3330074)
Are their wards in any Swiss Hospital? I’ve only see singles and doubles.

The most I've seen in a standard hospital is a room of eight. Psychiatric hospitals tend to have a max. of 4 people to a room, whereby attention is paid to the type of condition and that the single/double rooms are filled first, meaning a "general care" patient may have a single room if no private patients need it.

Nothing like the situation you may find in the UK, where even psychiatric wards may have a dozen people in them, with those on drug withdrawals in the same ward as people with depression. And I've seen people stood in hallways on particularly busy nights of Durham City's old Dryburn Hospital.

As for being refused what is considered supplemental insurance, unfortunately even the smallest thing is enough for that to happen. The good thing is that the general cover goes waaaaay beyond what you would have been used to from the NHS standard cover, unless you lived in a particularly wealthy NHS trust area. Even then, it'll likely be better here.

itsjess 21.07.2021 17:57

Re: Refused semi-private health insurance
 
Quote:

Originally Posted by bowlie (Post 3330074)
Are their wards in any Swiss Hospital? Iíve only see singles and doubles.

Ah, good point - that does change things!

When I was hospitalised in Portugal, I was also in a 'general ward' but I was the sole occupant, so I guess it was practically the same. I'm not sure if there are any other benefits to going semi-private :confused:

If there genuinely isn't much difference then I'm not too concerned, and of course without any experience in the Swiss medical system it's hard to tell. I'm in reasonable health (without wanting to jinx myself!!) and have only ever been hospitalised once, for the ankle break in Portugal.

I suppose if i'm ever sick / injured enough to require hospitalisation, I'll have more important things to worry about anyway!

itsjess 21.07.2021 17:59

Re: Refused semi-private health insurance
 
Quote:

Originally Posted by Kittster (Post 3330082)

Nothing like the situation you may find in the UK, where even psychiatric wards may have a dozen people in them, with those on drug withdrawals in the same ward as people with depression. And I've seen people stood in hallways on particularly busy nights of Durham City's old Dryburn Hospital.

What a horrendous situation, and how potentially damaging to those patients :(

I didn't have private cover in the UK so if I'd needed to use it, it would have been NHS all the way, so good to hear that anything here in Switzerland would still be a vast step up :D

Kittster 21.07.2021 18:07

Re: Refused semi-private health insurance
 
Quote:

Originally Posted by itsjess (Post 3330086)
What a horrendous situation, and how potentially damaging to those patients :(

I didn't have private cover in the UK so if I'd needed to use it, it would have been NHS all the way, so good to hear that anything here in Switzerland would still be a vast step up :D

It's grim up North... Or down South from your point of view, IIRC. It was quite a shock for me to see people in actual beds stood right next to the doors leading from the A&E area to the wards. Or waiting six hours to have an injury sutured. Sure, it was not serious, triage is normal, but even with a triage system, the most I've waited at any emergency medical service (including walk-in clinics) was maybe two hours.

Landers 21.07.2021 18:49

Re: Refused semi-private health insurance
 
I've waited many hours on a couple of occasions in Basel Unispital.
In general things are much better here but there are some things that are comparable, in a negative way, as the system here is also a kind of NHS.

"Private" insurance seems to get you that you see the senior doctors rather than juniors, but I wouldn't have nay idea other than what was mentioned already about what a semi-private package would contain.

NotAllThere 21.07.2021 19:06

Re: Refused semi-private health insurance
 
Quote:

Originally Posted by bowlie (Post 3330074)
Are there wards in any Swiss Hospital? Iíve only see singles and doubles.

Max 6.

Max actually occupied, 4.

runningdeer 21.07.2021 20:14

Re: Refused semi-private health insurance
 
Quote:

Originally Posted by bowlie (Post 3330074)
Are there wards in any Swiss Hospital? Iíve only see singles and doubles.

HUG has some pretty big rooms, it was a while ago but I remember being with 6 or 8 in the room.

Island Monkey 21.07.2021 20:38

Re: Refused semi-private health insurance
 
Unless youíve never had anything wrong with you, they seem to refuse. My husband was refused and heís never ill, but had multiple ski injuries in the past. Basic insurance seems more than good enough to me, the only thing Iíd like to add would be the option to be treated in all cantons.

Kittster 21.07.2021 20:42

Re: Refused semi-private health insurance
 
Quote:

Originally Posted by Landers (Post 3330100)
"Private" insurance seems to get you that you see the senior doctors rather than juniors, but I wouldn't have nay idea other than what was mentioned already about what a semi-private package would contain.

That is true for run of the mill stuff, however, if you are like me and have a rare skill in collecting various autoimmune diseases (currently up to three), you basically get fast-tracked regardless of how you are insured. Or maybe I just picked a good rheumatologist who knows the right people.

Island Monkey 21.07.2021 20:58

Re: Refused semi-private health insurance
 
Quote:

Originally Posted by Landers (Post 3330100)
"Private" insurance seems to get you that you see the senior doctors rather than juniors, but I wouldn't have nay idea other than what was mentioned already about what a semi-private package would contain.

When I was badly injured I got treated by a Professor, so you get what you need on basic insurance. The Reg's and Jr's also looked after me, but I had many visits form the Prof and I assume they were all reporting back to him.

I also saw one of the top consultant neurologists in Europe about migranes on basic insurance - though I think this was because he was they only person available in my local hospital :rolleyes:

bowlie 21.07.2021 21:12

Re: Refused semi-private health insurance
 
I donít have supplemental insurance, too many pre-existing conditions. But Iíve been treated by two professors and a bunch of top-rated physicians.

This isnít like the UK.

Anjela 21.07.2021 21:29

Re: Refused semi-private health insurance
 
Quote:

Originally Posted by runningdeer (Post 3330119)
HUG has some pretty big rooms, it was a while ago but I remember being with 6 or 8 in the room.

HUG was originally built to have 8 per ward for 'public' insurance, that was reduced to 6 about twenty years ago. As the hospital is gradually modernised the new norm is 4.

The best bit about having a private room is that you get a wine list! Annoyingly the last time I was in hospital I wasn't allowed to have any booze because it would've messed with the meds.

Murloc 21.07.2021 21:51

Re: Refused semi-private health insurance
 
some hospitals are abandoning the concept of multiple people in a room because of multi-resistant bacteria anyway.
I read an article about a new hospital having only single rooms. But other hospital systems are not following along, probably because it's expensive.

Tbh the only important difference is the room.

Susie-Q 22.07.2021 11:01

Re: Refused semi-private health insurance
 
I heard private or semi-private is impossible to get without your employer buying it as some kind of group package.

We applied for semi-private when we first arrived & were both very young & healthy - were also declined (I admitted to having asthma - perhaps that is what did it).

I have had one operation in Switzerland and paid the upgrade for private - many have advised that is the best thing to do rather than pay for an extra premium each month. I believe it cost us around 5000 CHF and was completely worth it.

meloncollie 22.07.2021 11:40

Re: Refused semi-private health insurance
 
Quote:

Originally Posted by Susie-Q (Post 3330264)
I heard private or semi-private is impossible to get without your employer buying it as some kind of group package.

We applied for semi-private when we first arrived & were both very young & healthy - were also declined (I admitted to having asthma - perhaps that is what did it).

Pretty much any chronic condition, and many one-offs, will be enough to deny private or semi-private insurance. If you move here as an adult, your chances of not qualifying are fairly high.

Or as in my case, having had a screening test at the age recommended back home, which was before the age recommended in Switzerland, was a reason cited. Irony: Having evidence of not having a disease disqualified me.

Quote:

Originally Posted by Susie-Q (Post 3330264)
I have had one operation in Switzerland and paid the upgrade for private - many have advised that is the best thing to do rather than pay for an extra premium each month. I believe it cost us around 5000 CHF and was completely worth it.

This option is something the OP should look into - usually called 'flex' something or other. You pay a small increase over basic monthly premiums, but then have the option to upgrade per hospital event. You then pay a fee of about 4-6K per upgrade. Often that's a significant savings over private premiums over the years. The qualification metric for these flex policies seems to be lower. But read the fine print! An upgrade for a pre-existing condition might still be excluded, YMMV.

Another option might be to upgrade out of pocket. Many hospitals offer this, based on availability.

Some hospitals will allow a room upgrade against a per night payment, some allow for an upgrade of doctor only, some require you to upgrade both care and room.

My local hospital used to allow a relatively affordable room upgrade (200 or 400 per night) but since ownership changed that is no longer available, one must upgrade care as well, which is significantly more expensive. Schade.

The local hospitals have four bed rooms for basic insurance and IIRC there might even still be a few with six at one hospital. A four bed room can get pretty grim; when your roommates have their families taking over the room 24/7 it gets pretty crowded.

On the plus side, though - more and more surgeries are now done outpatient, so you can avoid the multi-bed cacophony and recover quietly at home.

---

My 2P: Not having private insurance has meant that I have had trouble accessing the necessary level of physician expertise. As you can see from other posters, however, this has not been a problem for them. I would guess I have run into difficulties because I live in the boondocks, where expertise in short supply. In an urban area you likely have many more resources available.

However, when hospitalized your care is largely in the hands of nurses, especially if you are in for surgery, and out here, especially if you are hospitalized over the weekend or a holiday. So the issue of what level of physician expertise you can access in the hospital might be a moot one.

Landers 22.07.2021 12:36

Re: Refused semi-private health insurance
 
Quote:

Originally Posted by meloncollie (Post 3330277)
However, when hospitalized your care is largely in the hands of nurses, especially if you are in for surgery, and out here, especially if you are hospitalized over the weekend or a holiday. So the issue of what level of physician expertise you can access in the hospital might be a moot one.

And it's (some of) the nurses who have made my stays in hospital completely unbearable to the point of having PTSD now because of it.

itsjess 22.07.2021 13:00

Re: Refused semi-private health insurance
 
Thanks a bunch everyone, this has been really helpful. Good to know that my decline is not considered an unusual event.

I hadn't considered the option of upgrading on an as-needed basis but sounds like it could potentially balance out, cost-wise, comparing the increase in annual premiums vs the possibility of a once-off situational payment. This is good to know, I'll check back in with the rep.

@Meloncollie, your being declined due to having a test (which found no cause for concern) had me scratching my head for a good few mins! :wtf:

Quote:

Originally Posted by Landers (Post 3330293)
And it's (some of) the nurses who have made my stays in hospital completely unbearable to the point of having PTSD now because of it.

This is absolutely terrible to hear, so sorry to hear it Landers :(


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