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Old 16.03.2010, 21:00
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PRocessing claims

HEllo everyone!! I have been looking for the answers to my question but i couldnt find it...if its already been solved, my apologies!

Well i have an insurance with a low franchise (300CHF) And i have a previous condition that makes me spend quite a bit in medicines and stuff...well so far the very expensive stuff such as brain scans and x rays have never been billed to me. I guess its because my low franchise.

Anyhow, i now have the bills from doctor visits and blood test etc...and they sum up more than the 300chf franchise...therefore i need to start claiming for my money back and i just dont know how...my german is basic and i dont understand the woman on the other side of the line doesnt really speak english very well...

My doctor sends me two receipts...the real one and a copy. For the other doctors i only get one. I dont know if i should send the insurance company the originals and keep a copy or send the copy and keep the originals...or if it matters at all!?!??!

Another thing, how does it work with the year? I have some receipts from november 2009 and i wonder if they will be paid now in 2010???

Someone please enlighten me, i feel dumb!

Thanks forever!!!
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Old 16.03.2010, 21:06
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Re: PRocessing claims

Phone your insurance company - I am sure they can find someone who can speak enough English to sort it out for you....be courageous, not dumb...
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Old 16.03.2010, 21:06
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Re: PRocessing claims

Usually first you pay your medical bills and then send original to your insurance sompany to claim your money back. I do not think that it really matters if you sent original or copy as long as there is a proof of payment anyway (I might be wrong here though). I would contact jenny via private message on the EF as well as she may answer your insurance related questions more precisely.
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Old 16.03.2010, 21:09
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Re: PRocessing claims

Jenny is the undisputed Forum expert on health insurance but she has a business to run, so I suggest you search through her posts. I think your question has been answered by her before.

If not, try sending he a PM and she may help. But please don't bug her!
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Old 16.03.2010, 21:10
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Re: PRocessing claims

Quote:
Jenny is the undisputed Forum expert on health insurance but she has a business to run, so I suggest you search through her posts. I think your question has been answered by her before.

If not, try sending he a PM and she may help. But please don't bug her!
Does anyone care to read messages before posting LOL
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Old 16.03.2010, 21:18
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Re: PRocessing claims

Some basic answers:

All major work (hospital operations etc.) goes directly to the insurance company. It is the "smaller stuff" such as doctor visits etc. that you get invoiced for/need to pay and then need to claim back from the insurance company.

The insurance companies ask that you keep your bills until you have gone over the deductible (whatever level you chose). Then you can send the whole package to them. Remember, your deductible is on a calendar year. The counter restarts each January.

You need to send the original version of the detailed list you received of what was done by the doctor (this is a coding system called TarMed). If there is a copy, it will be for your records.

It is not a problem to send 2009 invoices now. Just don't leave it too late in the year.
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Old 02.04.2010, 19:37
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Re: PRocessing claims

Quote:
View Post
HEllo everyone!! I have been looking for the answers to my question but i couldnt find it...if its already been solved, my apologies!

Well i have an insurance with a low franchise (300CHF) And i have a previous condition that makes me spend quite a bit in medicines and stuff...well so far the very expensive stuff such as brain scans and x rays have never been billed to me. I guess its because my low franchise.

Anyhow, i now have the bills from doctor visits and blood test etc...and they sum up more than the 300chf franchise...therefore i need to start claiming for my money back and i just dont know how...my german is basic and i dont understand the woman on the other side of the line doesnt really speak english very well...

My doctor sends me two receipts...the real one and a copy. For the other doctors i only get one. I dont know if i should send the insurance company the originals and keep a copy or send the copy and keep the originals...or if it matters at all!?!??!

Another thing, how does it work with the year? I have some receipts from november 2009 and i wonder if they will be paid now in 2010???

Someone please enlighten me, i feel dumb!

Thanks forever!!!
I am kinda in the same boat as delfinita. I am a diabetic with a 500CHF franchise.
What I do is to write a letter (I write mine in English) to the insurance company. Stating what each receipt is, writing an amount owed (minus the 10% which the insurance company keeps). The insurance company wants the ORIGINAL receipt and the doctors prescription (make yourself some copies of this to keep just in case BUT the insurance company should send this back to you!). However, you will have to call and ask if someone speaks english so you can get the correct address to mail the letter.
The receipts from 2009 should be paid IF you are still with the same insurance company.
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