Telemedecine model: beware it can actually cost you more time and money (sanacall)

Dear prospective clients for a given mandatory insurance (Lamal).

Be very careful if choosing the "telemedecine" model, which appears at first to be a little bit cheaper.

This model, advertised as a way to reduce costs for the health insurance company but also for you, works this way:

Before to take the patient to any doctor, one must call the call center to receive first opinion or medical advice. It's only if they approve that one can physically go to a doctor (except for emergencies).

If so, they will grant you a time period which you can go to that doctor. If any bills are outside that period or in another doctor's name, the patient must pay it full and will not be covered/refunded as part of the Basic mandatory health insurance.

I will share gladly my experience with Sanagate/Sanacall model.

I am representing some girl who is not able to contract and manage the mandatory health insurance on her own. As such, I have the duties to deal with everything related.

1) The financials, for 2017 as per "priminfo.ch" the official health insurance comparison website ( Priminfo website :

Chosing 1670, Bionnens, for a child born in 2015, with accident insurance, and a children franchise of Zero, we get a cost, sorted the cheapest first:

KPT HMO CPTwin.plus 69.80 837.60 ---

KPT Médecin de famille CPTwin.doc 71.50 858.00 ---

Sanagate Autres modèles SanaCall 73.50 882.00 ---

EGK Autres modèles EGK-TelCare 74.50 894.00 ---

EGK Médecin de famille EGK-Care 75.70 908.40 ---

CSS Médecin de famille Réseau Delta Fribourg 75.90 910.80 --

...

Conclusion: Sanagate/Sanacall is not the cheapest and the difference in a year for another model, say with EGK-Care is 26.40chf, 2.2CHF per months.

2) The ombudsman of Fribourg region ( Ombudsman website informed me by phone that they are having a lot of complains about that particular company. I was told they are overchecking each bills made by the health professionals (doctors, hospitals, pediatricians...). As soon as there is a mistake, it's the patient's responsability to sort it out, which implies numerous calls, letters, efforts.

Also, he said that legally they can verify any bill up to 5 years and it's on the client (you) to provide evidence of wrong doings. He concluded by telling me that "now I should understand the logic and limits of the telemedecine model and I should understand what to do now before end of november".

3) I provide what I experienced with Sanagate/Sanacall:

-They are using another company called Medgate (Used by Sanacall also used by another insurance company EGK Telcare as per a phone conversation with EGK's advisor). They are the one in charge of dealing with the calls.

-Often I had to wait many minutes on the phone waiting list prior to be able to speak with anybody. Once it was over 20 minutes.

Now that seems to have improved a little bit, a recorded voice is saying for serious emergencies, there's another number to call. I have not tried that.

-The phone calls are recorded, which they clearly inform at the beginning. What they don't inform is that it's not used for medical purposes but can be used as evidence against you, for exemple when there is a conflict on the period to go to the doctor. I will advise you to clearly state at the beginning of each calls that you don't want to be recorded.

-The burden of providing evidence of any alleged wrong doings is to you, the client. Which means you need to prove anything that is going wrong, even if they are contesting something which occured years ago, up to 5 years as per the Ombudsman.

-It seems mandatory for you the client to track down each calls you are going to make, writing down the date, phone number, duration, summary of the conversation, etc... Why? Because they can use these records as evidence many months later, leaving you with nothing but altered memories.

I have the situation where they send me a bill in October for a treatment which occured in May, and a call to the telemedecine model in early February.

Nearly 7 months laters I'm being asked to give the phone number I used to contact them so they can access the recorded conversations.

With landline, mobile(s), work phones, etc.. it's not always an easy task.

-If any professional have made a false bill, for example charge you a few hundreds francs for some medical service you have not received, it's again to you to contest it. I contacted Sanagate who informed me that it's my legal duty to complain and they thanked me in advance for doing it.

While with a franchise of zero, one needs to either pay nothing or the "quote part", the 10% of the bill until it reaches 350CHF.

It implies you have to do numerous letters, contacts etc... so they can pay less and you get nothing but "email gratitude".

In the end, the false bill was over 350CHF, I had to pay 35CHF(quote part) or face hours of administrative corrections for an unknown results. Guess who lost 35chf?

-There is a important delay in dealing with the bills. For a treatment in May 2016, we got the bill near the end of October 2016.

-They are difficult with the bill are not being considerate in regards of evidence. For sanagate, since I don't remember 7 months later which phone I used to call the telemedecine, they are considering as valid evidence the only known number I gave them earlier. In other word they are ignoring the fact that I possibly used another mobile 7 -8 months earlier when contacting the telemedecine.

-In order to prove that their telemedecine center (medgate) had told me a period ending in April 2016, Sanagate has told me: "you can take an appointment with Medgate to listen to the call's recording in their head office in Basel". As if one person living in Fribourg will go to Basel for that. And as if nowadays we can not easily access any electronical recording remotely.

-One needs to pay in advance most of the bills, submit then online after scanning the prescription + bills and wait. Again there is a long delay prior to get refunds, in months.

-Their website for sending the bills has many issues. For example, in the french section some urls are always redirecting you to german language pages. Also, I had a few 404 *page not found*. It's tedious to send several bills one needs to do each time the process for each bills, it's not possible to send all at once. The initial registration took months as it was not working well at the time. I am Engineer in IT, so my computing skills are not the root cause. I have wasted too many hours just to send the bills and get the refunds for the basic mandatory health insurance.

-Sometimes I got the bills rejected with no clear explanation, again, I had to contact them for clarifications.

-They always check in details each bills send by the doctors, and I was not refunded for many medicine prescribed by the doctor which was not covered by the "LAMAL". When I clarified with the doctor and pharmacy, they said they don't know about all medicine so it can happens. Some doctors will write a note saying "I'm allowing the pharmacist to give a generic alternative", sometimes they don't. Sanagate always checked everything leaving me with hundreds of additional francs to pay.

-We did not use the LAMAL insurance a lot and respected the "telemedecine model" by calling each time during the entire year. They are claiming that the "opened period" to go to the doctor given by phone in February was ending in April and not in May. As a result they are refusing to refund a 147CHF doctor's bill which occured in may. In that case, no more basic insurance, no more franchise, no more quote part, nothing: all the bill has to be paid in full by yourself.

Imagine if it would have been a more expensive bill from a specialist for example! In practice it's equal to have zero health insurance at all if any misunderstanding occured during the phone call with the telemedecine model.

I probably have many other experiences to share about them, I would rather stop here. I have lost too many hours with that telemedecine model in complaints, refund related administrative burden, calls. I have lost too many francs for giving up legitimate claims as the administrative burden counterpart was widely imbalanced against me.

Yet I saved a few francs at the time of comparing different mandatory health insurance companies and models...

I could try to find the positive experiences I had with them, honestly after a few minutes I still haven't found any...

You have been warned!

I don't have the influence or right or anything to make you suscribe to another insurance model or company. I wish I could tell myself back in time and advise me: "Don't suscribe with Sanagate/Sanacall".

PS: I have evidences of the above, if the insurance company is willing to threaten me in a legal way, I will gladly take the fight further.

Feel free to share your own experiences with that model or insurance company.

What's the alternative? A normal insurance with the "Tiers Payant" which means all bills are sent directly to your health insurance company, without any burden for the client.

WOW!

Thank you for all the information, I am currently checking out various options for me and my daughters.

Let me put it like that,the telmed stuff is off the table now.

Thanks!

EE

Yes, even the FRC (Federation Romande des Consommateurs) (association to protect consumers) are warning about it.

They want everyone who have issue with this type of model to report them so they can take it at federal level and also act with insurers:

translation of the FRC website

Quoting an extract from above:

"Opting for an alternative insurance model saves on the health insurance premium, but also obliges the insured to comply with a number of constraints and rules, often complex and highly variable. And as the slightest misstep is usually punished by a refusal of care , mishaps are common for those who choose a family doctor model, care or telemedicine network."

Translation: you make any mistake, you will be liable for the bill, in full, regardless of your franchise or quote part.

For your situation, I suggest you compare using the official website>

http://www.priminfo.ch/praemien/index.php?sprache=f

Then read the details of the insurance you want.

If you have any doubts, don't hesitate to ask (me or others). "we" (if there is such thing as "me + others") are much cheaper than any official adviser, in fact we are free

Thank you Corsebou.

I already checked and rechecked via comparis and other sites......I am not new to the entire malarkey with the insurances and I am one of the people who voted NO! back then in 1994.

Ah well, currently spending hours online checking out the various insurances printing out possible new policies....time is pressing, by end of next month it all has to be sorted.

Really time consuming when you can't make phone calls anymore but I will get there in the end, always have.

Not all telmed insurers work as you described. Many seem to tolerate a failure to call the phoneline with the consequence of switching you to standard modell with increased premiums after a warning.

Comparis has an overview by insurer here (dated 2014): https://www.comparis.ch/krankenkasse...ar/telmed.aspx

This is an excellent post, but unfortunately the troubles are not new... the reasons mentioned are exactly why I left them 6 years ago.

I can even add some complaints of my own about Medgate:

- when you clearly select French as your language, the nurses answering you can barely say hello in French. Trying to communicate about medical issues with someone who has an A1 level in French is downright useless

- the medical advice can be dangerous. When I was pregnant with my daughter, I came down with a fever and flu-like symptoms. The Medgate nurse told me to take paracetamol and wait until I got better. Later on, my OB was terribly shocked about it: fever can be very dangerous to unborn babies, and lead to potentially serious complications.

My experience with Medgate (CSS Arcosana) till now is quite positive. We are in CH 8 months already and during this time I managed to get ill quite seriously twice. First time I was 8 months pregnant and has a sort of a virus which due to pregnancy turned into 3 week long torture. Medgate doctors were extremely helpful and they spoke English without any problems. Doctor even called me next day to check if I am getting better. Due to this service is free I did not have an necessity to go to doctor, so there were no additional expenses. Second time I was intoxicated with food when my baby was just four months old. Due to I had temperature more than 40 tC and other unpleasant simptoms I was suggested to go to hospital ASAP. What I actually did. In my case all my bills (due to pregnancy and now pediatrician check-ups) go directly to insurer and they send me other bills if there is something left I need to cover (e.g. 10% for baby healthcare). When we noticed a couple of mistakes in the bills, everything was solved quite quickly by making a couple of telephone calls. Although I must admit that the bills are coming with a big delay (3 or 4 months).

Sorry to hear of your troubles.

On the other hand, I had to call on behalf of an elderly friend few times and my experience with the access, advice and helpfulness of the doctor on the other side of line was quite positive. Don't know much about how the billing went.

Some of your problems seem to be more to do with the insurance company ethos than the Telemedicine channel per se e.g. overly vigilant bill checking, delay in repayment, website issues, billing mistake by doctors.

I used to have Sanacall & my husband still does. Never had a problem with it.

As long as you stick to what they say I don't see an issue i.e. "You're cleared to see that Dr 3 times in the next 30 days". If that Dr referred us to someone else, we just called the call centre to inform them and they made a note.

I have Helsana "Benefit Plus" package via Medgate and I am very happy with it. Medgate provides quick responses, and they give feedback via email when I want, where it is clear until when I am allowed to visit the doctor for every case. Actually, I am now looking for a new insurance (to save some money because of the increases), and access to Medgate is on my wish-list. We are probably switching to CSS, who also have a Medgate-based package.

It is true, however, that one must be careful when using this "Telemedicine" option, because there will be penalties if the terms and conditions are abused. After all, this is why this option is cheaper! So far, I have been lucky (and careful).

Exactly. One must be very careful.

As far as being cheaper, that is in most cases far from truth.

1) Financially, I posted the number above, the telemedecine in the exemple above is not even the cheapest model.

2) You are going to pay in phone costs, mails, and plenty of additional time wasted. And not for "complaining", time wasted for normal day to day administrations like sending your receipts or the likes.

3) Any mistakes will be costly. In fact even ONE mistake can lead to thousands francs lost. Since in the terms and conditions they clearly mention that, and there is nothing you can do.

In fact it's like the "Sword of Damocles".

You have to be very careful of the sword will fall in your head. And that will be painful (to the wallet).

Is that really worthy for apparently, in the best cases, a few francs a year?

It's worth pointing out there are 2 different Telemedecin models.

Compulsory medical consultation by phone and free choice of doctors thereafter

Compulsory medical consultation by phone and binding treatment.

I would not recommend the 2nd one.

We have also had positive experiences with Medgate through Arcosana. Maybe it helps that OH is a doctor and I work in pharma so we can explain the problem we have and what we need. In general, we only phone for a prescription and can then pick up from the pharmacist within 30 mins, so we save a lot on appointments for a simple task.

Our last bill took at least 4 months to come through, though I don't know if the doctor was slow too. However, I don't mind when it is me owing them money!

I would recommend the TelMed model to anyone who has some scientific/medical knowledge.

This, exactly

I used to work in a hospital, and one of the functions of our department was a triage line, mostly pediatric, manned by registered nurses. The Tel Med model is similar to this, so I felt comfortable selecting this. I'm not clinical, but I've had a lot of work/patient/caregiver experience. Our bills can be slow to come as well.

Sanagate adding salt to the wounds, not only they take months to refund the bills, and make numerous mistakes, they also suppress your "online account" at the end of the year if you naturally ditch them.

Normal? Somehow yes, but that prevent the customer from checking each of the uploaded bills, upload latest bills (which are coming late as usual in Switzerland) and verify the latest "bill sent" vs the refunds.

In other words, it makes it even more difficult for ex-customers to get their refunds properly.

Of course, I checked and they already made mistake, which needs to be sorted in writing, by me, wasting a lot more time again.

As if they could not grant a "grace period" to allow the painful and stinky relationship to end without too much troubles...

I can not possibly think of a worse health insurance company in Switzerland, and I already been through several.

Little update, as usual they are attempting to drown me in administration in order to prevent me obtaining proper refund.

I had to inform them by phone for a medical emergency while the baby ensured was abroad. Normal.

I send them the bills using their tedious and buggy system. Normal.

Months later, I have a refusal by mail because I have not filled their "survey" for emergency treatments abroad.

3 pages, 18 questions including some which appears highly irrelevant and intrusive like "why and how long you were abroad", "have you subscribed to special insurance for holidays somewhere else"...

I'm in for numerous hours again checking the legality of that approach and what else I can do for that person insured. That person can not speak the local language and is ignorant of the system in place. I can imagine how easy it is to abuse these persons in weak position and how stressful it is to deal with these type of companies.

PS: I did question them on how they should have shown a proper error message when they "terminate" access to their online system, the employee was rejecting any blame, as usual and not providing any real solution.

Each times it's going deeper and deeper, they are reaching new levels of mediocrity.

Thank you for the information.

Just to add up to the positive reviews of the telemedicine system: I've had a great experience with this model with CSS Arcosana. I like the idea of having a doctor to call for minor things and do it quite often. They even sent a prescription to my nearest pharmacy once. Also, my wife has had a few health issues and has been admitted to the hospital twice in the last year, but we've never had a problem with CSS.

As someone pointed out, your problem seems to be more with the insurance company than with the telemedicine model itself.

Sanagate is Helsana, right? I've been on the standard model for ever, but looking to change since the only doctor in our new village is on all the Hausarzt models anyway.

I do find there are (insurance) companies that seem to deliberately bombard you with (mostly unnecessary) paperwork, and their own paperwork have contradictory letters that cross in the post, with the result that tracking what's going on with who owes whom what is virtually impossible. From very straightforward dealings with other insurance companies, I can only conclude it's absolutely deliberate.

It seems to be CSS but is also associated with other companies.

http://www.caisse-maladie.ch/Sanagat...e-maladie.aspx

While I agree that Sanagate/Sanacall is by far the worse insurance company I ever had, the "telemedecine" model has also a lot of possible flaws, by "design". I like to compare it with having "Damocles Sword" hanging upon your head.

There is a lot of special conditions to respect, and serious significant financial consequences in anything is not well understood. And a lot more of administrative burden than the models with "Tiers Payant" (as opposed to Tiers Garant) where it's the insurance company handling bills and paying for it first. There is often no "warning" and one mistake, which could have happened when you were weak and not fully capable, can result in many thousands francs lost. All that for an alleged saving of a few francs per months...

Don't take my word for it, take it from a Swiss institution who list a long list of the possible issues, you will see they are even collecting feedback from people who have not been refunded from "Telemedecine models".

http://www.frc.ch/articles/fiches-produits/

As for your great insurance, I had a 5minutes glance, and I already see a potential problem:

https://www.css.ch/downloadpdf.html?...charset_=utf-8

If you are ill abroad you need to fill a very intrusive 5 pages questionnaire. And you must have a clear description of what happened in English or in one of the Swiss national language, from the health provider abroad.

Good luck with that if in any eastern Europe countries, Spain, etc...

So you don't know the consequences, but in theory, they could refuse to refund you, as per non respect of the rules and contract.

I know how it works with Sanagate and I know which option they are choosing if such issue arises, the one were you end up not having refund.