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.