I recently changed health insurance provider, when I stopped being a PhD student. Before, I was insured with SwissCare. They only insure foreign students, with an insanely cheap 65CHF/Mnth premium. The catch is that I had to pay my bills up-front, which are around 10k+ per year due to a recent diagnosis, and then send through all the invoices as a claim.
Now, I'm insured with Assura at the normal going rate (although I've reduced the franchise to the minimum.) But - I STILL apparently have to pay up front for all medication, consultations, my regular MRIs etc. It's not what I expected at all - thought I just show the card and the pharmacy/hospital deals directly with Assura. It's a lot of admin and presents cash-flow problems for me when a 5k bill comes through.
Is this normal? Are other providers different in this regard? I'm discussing this with Assura on Monday but I wanted to find out other peoples' experience.
Thanks so much in advance, to this kind community.
Yes, that is normal. It depends on what insurance you have, some ask you to pay upfront, some will pay the invoice and claim back from you later, if required.
There are 2 different systems, as mentioned by other above: Tiers garant and Tiers payant. You have now had two insurances in Tiers Garant, which means you pay upfront and get back from the insurance.
Tiers Payant would pay directly to the DRs/hospitals etc and then come to you for your part of 'Selbstbehalt' etc
Same here, I'd say for me ~60% of invoices goes to the insurance (and then they bill me for the deductible) and ~40% goes to me directly, so I pay and send it back to the insurance. It seems to depend on the medical office, I asked one of those who do it and they simply replied that that is how they do it, they always bill the patient.
Some insurance companies (LaMal) accept direct billings from doctors and pharmacies, so you do not have to front the money. Others like Assura do not work on this model.
The way you want to manage things from a cash-flow perspective is the moment you receive the bill from the doctor, you send the bill with a cover letter giving your bank details etc. to Assura. In most cases, Assura will pay you in time to pay the doctor before that bill comes due. Be sure you pay the doctor's bill as soon as you have the transfer from Assura, so you do not mix this money with your own.
Some doctors will agree to send the bills directly to Assura. Normally you need to ask them if they are willing to do so. You may need to sign a request so they do so. This avoids the steps above.
When it comes to prescriptions, you can use a credit card and send the receipt to Assura the same day. Be sure you send the copy that is marked Assura and not the one for your file. In most cases, you will receive the money in time to pay the credit card (depending on the billing cycle).
If you know you will always have a lot of bills and go over your franchise, I'd highly recommend switching providers and lowering your franchise/deductible. I used to have Assura, but it is a right pain in the ass if you are actually sick and you have to manage the billing yourself.
I have long-term health problems and reliably have several thousand francs worth of bills each year. My deductible is 300.- CHF and I tend to go over it by mid-January. I am with Helsana which is a bit expensive, but the paperwork is pretty much zero. Was especially grateful for their amazing professionalism and service when I had cancer and my bills topped 35,000.- CHF.
The difference between high and low fanchise is minimal.
Take the prime for both high & low, X 12, add the franchise on and see what the difference is........
The advantage of a high franchise is, if you do NOT use your insurance or not too much, then you are far better off.
If you cannot afford to pay for treatment, doctors, hospitals, clinics, then have them send the bill directly to Assura and they will pay and invoice you whatever amount you need to pay.
Most hospitals/clinics will not invoice dorectly a client, they prefer to work directly with insurance company.
Generally, you can cancel the mandatory health insurance provider at the end of the year only. However with the minimum franchise you can also cancel per June 30, with 3 months notice - you may want to enquire whether you have to pay the franchise twice by canceling midyear.
As for the insurances/insurers available at your location, and their price, see priminfo.admin.ch .
I'm with Asssura and it works both ways. Sometimes, the invoice is sent directly to Assura, sometimes I pay and then I get reimbursed from Assura.
I don't remember the terms precisely but I do remember what happened. For ear surgery in cantonal hospital: invoice sent directly to Assura. Pharmacy/drugstore bills, I payed them and then send the invoice to Assura. Follow up MRI and doc visits, got the invoice and got the reimbursement from Assura. The surgery + 2 nights in hospital invoice was near 10K. All others around 200 CHF. From an optimistic point of view it's nice that the large invoice was sent directly to insurer and I only had to deal with the small ones.
However, there's a more recent invoice for a service I think we all used that got sent automatically to insurers: the cost of covid19 tests. At least I got a letter from Assura tellig the covid test was taken by them and they were invoicing me for 0 CHF.
PS, I remembered there's no way you pay 5K to the insurance. I have the cheapest insurance and my deductible is topped to 2500 or 2700 CHF per year. Other insurance primes have lower deductibles. So, I guess the "damges" are limited to less than 3'000 CHF.
I'm with Assura and in most cases I get billed directly by the health provider and have to claim back from Assura. A few providers bill Assura directly but I've never understood the where and why of which provider and under which conditions.
Indeed, I remembered I reached to a limit and all costs above that were taken by the insurance.
Thanks for the details. I think OP can plan taking into account the limit around 3K per year. The precise limit should be somewhere in the insurance policy.
The article I posted from 'Bon à Savoir' consumer magazine in Romandie says only if lowest franchise
Just read this in 'Bon à Savoir' Romand Consumer magazine.
''You can actually change mid year, but only in very specific circumstances, eg if you have basic insurance with the lowest 'franchise' of 300.- and without specific conditions (as in via own GP or approved doctors' list, etc).
In such a case you can change for 1st of July, providing your letter reaches the Insurer on 31st of March.''
Agree with what others have suggested in terms of cash flow. You can forward the claim immediately to the insurer and likely get the reimbursement for at least part before the bill is due.
But watch the due dates of bills carefully. Although most bills say payable within 30 days, some have a shorter time frame. My dentist gives 10 days.