Hi all, hoping to get some advice on what to do about my current situation.
I had an accident whilst skiing back in January. I fell onto an outstretched palm and probably sprained my wrist. At the time I didn't realise that accident insurance covered accidents from outside the workplace, so decided to just put my hand in a splint and rest (as I assumed that this would be the advice from medical professionals anyway).
Six months after the injury I was still experiencing pain. I was also informed that I would be able to claim against my accident insurance covered by work, so I decided to do this as the wrist wasn't getting better by itself. We filed an accident report and I went to the doctor a few days later.
Since then I've been to the doctor twice, received medication, and, since the injury still hasn't improved, was recently sent to a specialist for x-rays and other exams.
In a letter dated after my most recent appointments, my accident insurance informed me that 'there is insufficient evidence linking my current injury to the accident reported', and that they will be transferring costs to my general insurance. Because I have the largest possible excess, this will result in a bill of potentially several thousand CHF for treatment I had already received by the time of this notification. I have now cancelled all my follow-up treatment since I don't want to be left fronting the bill for what looks to be some pretty expensive treatment.
Has anyone had similar experiences with their Unfallversicherung refusing to pay for an Unfall? I'd like to get some advice on how to proceed, since the injury still hasn't improved and I don't know what's wrong with it, but am reluctant to pay for expensive examinations if the response is likely to be 'stay home and rest' (which is what I'd already been doing, at no financial cost to myself).
In something of a Catch 22, the Unfallversicherung say that if I go for more scans and it turns out there is a causal link between the accident and the injury then they will cover costs. But of course I have to cover those investigations upfront myself and have no idea what the outcome will be...
Highest deductible in mandatory health insurance is around 2'500 CHF, so no need to be abtruse on purpose. Well, all subsequent treatment cost above those 2'500 CHF are covered by health insurance. But, there's an important issue. We're on the 29th of September, all costs incurred until Dec 31st will be covered by those 2'500. 1st of January 2023 the count resets and you might be liable for more deductible.
Back to accident insurance, what does your employer that pays for it says? Are they supporting you?
Did you report your accident to the accident insurance within 48 hours, or however long you have to report? We have been warned to do that. If you did not, I'm not sure you have a leg to stand on here.
Do get the treatment, as you will need your wrist for the rest of your life.
As Liquidpaper have mentioned, you need to inform the accident insurance asap from the day of the accident. You need to talk with your employer and see how to proceed.
I too suggest not to stop treatment, having a good wrist is much more important than the deductible. If you expect the treatment run into next year, think about changing the deductible to a lower amount for 2023.
not several thousand, the maximum will be 2500+700 = 3200 if all billed within the same calendar year. If you ask me, I would prefer a healthy wrist over having 3K more in my bank account it.
The accident insurance declines to cover it because it has been 6 months since the injury which you didnt report to them on time. So they are argumenting that something else happened since then, which was not an accident (e.g. overloading the wrist in the gym or whatever their explanation is).
I would put pressure on the accident insurance explaining again when it started and what you did as first steps to deal with the problem. It could help if you had witnesses or photos of the injury.
Generally it is not that smart to stop treatment just to save 3K CHF.
Which is more important to you? Saving a couple of thousand Francs or avoiding long term health issues and pain? You obviously have a series medical issue and it is not clearing up. Cancelling treatment is a very foolish action.
Forty-eight years ago I use to play a lot of football and suffered several injuries on my left foot as a result, now it was not a case of not getting treatment, the types of treatment were just not there at the time. Today I can walk about 300m in aided in the mornings and down to 50m or so in the evenings. Had today's treatments been available then, I would not be like this.
Cop yourself on and look after you health because the long term costs may be far more expensive.
Thanks all for your advice. You're right that the accident was a long time ago and this is presumably the grounds for refusing to pay. Regrettably I don't have any photos taken at the time. As I said, I didn't go to the doctor initially because I didn't realise that it would have been covered, and I didn't know that I would still be having a problem.
My reluctance to continue with my treatment is based on the lack of results so far. Every consultation has ended with "we can send you for a follow up scan if you like but we don't know what's wrong; go home and rest". 3000 CHF is all the savings I have, and if the result of further inquiry is the same then I've wasted it.
Is there generally an option to finance large medical bills over several months?
You may not need that, talk to your provider. Hospitals for instance are generally flexible. Also ask them about a reduction of the bill, or where you might get support.