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Old 24.08.2009, 20:43
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You MUST pay first, before insurance pays?

I received a 6,000 chf bill from my Dr (extended medical program cost).

I have been informed in the past that the patient must pay the bill to the Doctor FIRST, and then the insurance will review the claim.

However, my question is, why can't you submit your insurance claim first, and see if or what they pay?


Any info would be so helpful... 6K is a lot for me!
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Old 24.08.2009, 20:54
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Re: You MUST pay first, before insurance pays?

It is normal that you pay a doctors bill yourself and then claim it from your insurers. However, if you are with a good company you should get the money within 2 to 3 weeks whereas you have 30 days to pay the doctor.

Send the bill to your insurer immediately andb you should have the money before you have to pay the bill.
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Old 24.08.2009, 20:55
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Re: You MUST pay first, before insurance pays?

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... why can't you submit your insurance claim first, and see if or what they pay?
Just because you're the customer to both the insurance company and your doctor, don't think they have you at the heart of their 'Best Interest' chart.

It's all gravy, and we're the turkeys

(Oh sorry, the British NHS is evil. I forgot...)
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Old 24.08.2009, 20:56
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Re: You MUST pay first, before insurance pays?

I have found large bills especially for 6k etc.... are normally sent direct to the insurers or if we have received them i send them direct to the insurer, we pay smaller ones up front but i really don't understand how people are expected to pay amounts like this up front themselves
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Old 24.08.2009, 20:58
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Re: You MUST pay first, before insurance pays?

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I received a 6,000 chf bill from my Dr (extended medical program cost).

I have been informed in the past that the patient must pay the bill to the Doctor FIRST, and then the insurance will review the claim.

However, my question is, why can't you submit your insurance claim first, and see if or what they pay?


Any info would be so helpful... 6K is a lot for me!
I've had some high medical bills too. Submit the bill straight away to your insurance company. Look at your payment terms with the doctor. See how much reminder bills are going to cost you. You might be able to delay paying the doctor until insurance pays the bills or ask for a payment by installments with the doctor.

You should only have to pay your excess amount and then 10% of the remainder. Call your insurer - they should be able to tell you how much they will pay.
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Old 24.08.2009, 21:07
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Re: You MUST pay first, before insurance pays?

Those anticipating very high medical bills can contact their insurer in advance. The insurer then issues a promise to pay (in German a Kostengutsprache). Based on that the practitioner can directly claim from the insurer.
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Old 24.08.2009, 21:18
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Re: You MUST pay first, before insurance pays?

When you say this was for an extended medical program do you mean that this was several consultations over a period of time ? If so, I would ask your doctor to bill you for each consultation in future to keep the bills in more reasonable proportions.

As for seeing ‘if or what they pay’, they should pay everything unless you have had some treatment that is not covered by the basic insurance and you do not have supplementary cover. However, the doctor is obliged to inform you if any procedure is beyond the basic cover.

The insurers have to operate the basic insurance on a non profit making basis so they have no financial motive to try and reduce the claim.
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Old 24.08.2009, 21:28
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Re: You MUST pay first, before insurance pays?

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....The insurers have to operate the basic insurance on a non profit making basis so they have no financial motive to try and reduce the claim.
Insurers are trying desperately to keep premiums low. Higher premiums mean that some customers will switch to another insurer. Then the insurer is stranded with high fix costs and premiums must go up again.

So insurers are motivated to be tight fisted. Most are fair and almost all are strict.
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Old 24.08.2009, 22:44
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Re: You MUST pay first, before insurance pays?

Interesting...after 4 yrs, I am switching from a US expat insurance plan to a Swiss plan. I thought the main advantage was that I would no longer have to pay the Dr. fees up front and submit claims for reimbursement. I have not read the terms of my new contract (thanks to our resident insurance guru Jenny), but I hope that I do not have to deal with bills...especially for pharmaceuticals. Can anyone clarify if there is a 'typical' scenario with Swiss insurance plans...

Thanks,

fduvall
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Old 25.08.2009, 06:57
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Re: You MUST pay first, before insurance pays?

Guess it depends on your insurance. I have a card issued by the insurance company, which I show to the doctor, hospital or pharmacy. Any and all bills are sent directly to the insurance company and is paid directly by the insurance company. I have to pay all amounts up to my deductible and 10 percent of any medical bills. Accidents are fully covered and I have to make zero payments. This also includes any bills in foreign countries. I am covered by Sanitas .
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Old 25.08.2009, 07:30
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Re: You MUST pay first, before insurance pays?

Well since insurance operates on a principle of indemnity you should actually pay up front and then claim for reimbursement - that's just the way it works in theory (and sometimes in practice too). Usually if you have larger bills or expect them it would be a good idea to get in touch with your insurer as soon as you can, insurance companies are normally reasonable and they don't much like nasty surprises in the form of unexpectedly high claims.

IN our own experience we had claims for some tens of thousands of CHF and in that case the doctors/clinics contacted the insurer direct and settled everything between themselves - this worked very smoothly.
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  #12  
Old 25.08.2009, 08:42
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Re: You MUST pay first, before insurance pays?

This must differ between insurance companies.

All my recent medical bills have been a matter between the insurance company (Zurich) and the hospital. The only bill I have seen was for the ambulance ride (expensive taxi, that, but hey - it came with drugs ) which the insurance company also payed directly.

A cople of years ago I had occasion to visit a specialist and the insurance company (Helsana) also paid the bill direct.
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Old 25.08.2009, 09:02
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Re: You MUST pay first, before insurance pays?

I have sometimes sent the insurance company the bill together with the payment slip, they have always paid the bill and adjusted the premiums accordingly. I never pay a medical bill until the insurance company has paid their part. I always try to send the bill to the insurance company as soon as I receive it.
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Old 25.08.2009, 10:09
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Re: You MUST pay first, before insurance pays?

Thank you everyone for your input! I think I'll do as some of you suggested and just send the bill immediately and hope I receive payment before 30 days are up.

Thanks again!
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Old 25.08.2009, 17:40
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Re: You MUST pay first, before insurance pays?

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This must differ between insurance companies.
Mine seems to depend on the doctor and then what I fill in when I see the doctor for the first time. Some doctors have the option of sending the bill direct to the insurance company, some don't. My personal preference is to get the bill first. You can then see information such as tests done and double check. With pregnancy I wanted to check the names of the tests done and that I had all the injections for my negative blood type.
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Old 26.08.2009, 12:43
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Re: You MUST pay first, before insurance pays?

Intras actually tells you to send them the bills immediately since they reimburse within the month leaving you enough time to pay the deductible.
In cases where the doctor sends the bills straight to the insurance company, I've actually received an invoice from them charging me the deductible. I thought that was pretty neat and a vast improvement on how things used to be.
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Old 26.08.2009, 12:50
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Re: You MUST pay first, before insurance pays?

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I received a 6,000 chf bill from my Dr (extended medical program cost).

I have been informed in the past that the patient must pay the bill to the Doctor FIRST, and then the insurance will review the claim.

However, my question is, why can't you submit your insurance claim first, and see if or what they pay?


Any info would be so helpful... 6K is a lot for me!
you don't mention your insurance company, that would help.

Typically, with Swiss policies, you get the treatment that most describe here - but it depends on whether the doctor bills direct to the insurance or not. My GP, for example, sends me the bill.

Accident insurance is more likely to be a breeze. I've never seen a bill for anything but soft drinks and TV rental from accident claims...! That includes ops, staying in hospital, physio and other treatments.
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Old 02.09.2009, 15:13
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Re: You MUST pay first, before insurance pays?

i went to see a doctor in MAY i didnt receive anything from him or the Insurrance yet,i went to see another one ,he send me the bill that i bring to the aInsurrance company the White Form they need,after 3 weeks i got my money minus the 10 % copay and pay him,i did also got a prescription
medicine and went to the pharmacy,the Pharmacy offer me to supply me my Medicine and told me if that will be alright i say yes,they keept the prescription from the Physician,gave me the Medicine,i didnt pay them a dime,and got about a month after a paper from the insurrance that they have pay them minus the 10 % copay,so i guess i will get a bill for the copay,i guess doctors are different,some expect you to pay and send you the bill that you pay and you wait to get the money back from Insurrance minus the copay,but you still have a month to pay the doctor,so you can bring the Wwite paper to the insurrance and wait to get the money to pay the doctor,before the due date ,and some other doctor directly do that with the insurrance.
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