Is it possible to request partial or full reimbursement of expenses from social services if the surgery was medically necessary and in fact not available in Switzerland?

Family, Education, Health and Pets
1

I had a very rare vascular disease worldwide. In Switzerland, the planned operation was cancelled, and afterwards I was refused treatment and referral, even though my condition continued to deteriorate. The reason for all cancellations and refusals was the same — this disease is not surgically treated by Swiss surgeons. As a result, I was forced to undergo the operation abroad at my own expense. The procedure was successful, and the diagnoses were confirmed. I am currently dependent on social assistance.

I have basic health insurance, and the social services were prepared to send me (through my treating physician) to any clinic within Switzerland. For treatment abroad, however, they required a second medical opinion. I was unable to obtain such a second opinion because Swiss doctors had no experience with my diagnosis.

Is it possible to request partial or full reimbursement of expenses from social services if the surgery was medically necessary and in fact not available in Switzerland?

2

Can your treating physician talk to your insurance company directly.

In my case my medical device was not covered by LAMAL but after talking to my insurance company experts they agreed to cover the costs.

He wrote a prescription and I sent that in with the first invoice and it was covered subject to franchise and copay.

3

I would expect that reimbursement is possible but requires pre-approval. The second opinion the insurance demanded is the first step of this process, the confirmation of the diagnosis and affirmation that you needed the treatment in the first place.

1 Like
4

Sounds like this is between you and your health insurance and nothing to do with social services.

1 Like
5

Not sure why they couldn’t use Google like any other doctor in this modern world.

Mine didn’t know how to do a procedure on one of my kids so he had a quick look on YouTube!

1 Like
6

This is a complex issue.
In the case of complex and rare diseases, the surgeon’s experience and competence play a significant role.

Agree with me — if something goes wrong during surgery, YouTube won’t help anymore.

7

You could have maybe asked the insurance if a second opinion could come from an expert Doctor abroad. Probably too late now.

8

It’s never too late to ask.

1 Like