The crisis between insurers, clinics and doctors is not completed in Geneva. Even if some agreements have been found, hundreds of insured are in a conflict situation with insurance. Non -reimbursed health costs, services that are still refused: the situation gets away.
Since the beginning of the year, the majority of insurers have refused to systematically reimburse care in clinics to their customers for private or semi-private coverage. After months of unsuccessful negotiations, agreements on a case -by -case basis made it possible, on paper, to return somewhat to normal.
>> Read on this subject: The Tower Hospital and the CSS have reached an agreement et CSS and Helsana agree with two private clinics in Geneva, towards an end of the doctors-assured conflict
Some insureds have still not been reimbursed for medical interventions. This is the case of Marion, who gave birth two months ago. Just before the birth of his son, his semi-private insurance tells him that he is only responsible for a delivery by low and without complications.
“Unfortunately, it did not go as planned, we finished in an emergency cesarean and under general anesthesia. Beyond the fact that it was hard for me, I had the unpleasant surprise by receiving the counts that they were not going to take care of several thousand francs,” testified Marion in the 7:30 p.m.
“Solutions are looming”
This young woman finds the situation unfair, while she has been assured in semi-private for eight years. “We cannot pay this amount today. We are stuck financial level. The arrival of a second child is already quickly complicated. I already have requests for extension for bills of invoices and we hope that the procedure with my lawyer can succeed somewhere.”
Contacted, the maladie’s umbrella indicates understanding patients’ concerns, but delayed. “Solutions are now more and more clear. We are convinced that a good solution may be found soon, in the interest of all the parties concerned,” she said.
More than 300 files concerned
Me Marc Balavoine, the lawyer to which Marion appealed, is the chairman of the health and patient rights monitoring commission. In total, it processes more than 300 patients of patients in conflict with their additional insurance.
“We still receive almost daily files, new, people who find themselves faced with refusal of services from their insurance,” says Marc Balavoine.
“I think there is a huge gap between communication that can be made by insurers, and press releases that can be read of certain insurers, including clinics, and the reality on the ground,” he observes.
Private insurances say they have found agreements with a number of clinics. But according to this lawyer, a patient still has no guarantee to see his reimbursed services, for the absence of agreement including doctors. He will now turn to the courts.
Micaela Mumentaler/Asch
