Complementary insurance no longer reimburses all operations of Vaud and Geneva clinics – RTS.CH
Additional insurance no longer systematically reimburses services in private clinics. After Geneva, this phenomenon also affects other French -speaking cantons, notably Vaud. The rupture of an agreement between doctors and insurers, due to a dispute over pricing, is at the heart of the problem.
In 2020, FINMA, the Federal Authority for the Surveillance of Financial Markets, notes that invoicing in the field of additional insurance lacks transparency. Insurers and doctors had until January 1, 2025 to find common ground on a new pricing system. But the discussions have not succeeded.
This conflict does not oppose insurers to the clinics, but rather to the doctors who exercise there as an independent. The showdown is particularly strong in the cantons of Vaud and Geneva. If proposals have emerged on the one hand and on the other, they have not made consensus. Insurance companies believe that the pricing model chosen by doctors’ associations makes it possible to overflow and do not comply with standards. Doctors denounce a threat to their autonomy and constant pressure to blindly lower the prices.
Agreements on a case -by -case basis
Since January 1, the absence of a global agreement therefore prevents the implementation of a generalized agreement between additional insurance and doctors of the clinics.
In Geneva, three insurers agreed to operate according to a system set up by the association of Geneva doctors. This would represent 40% of the insured in the canton.
In the canton of Vaud, doctors have accepted an agreement which is denounced by their federation in order to be able to continue to operate.
A blurred situation for patients
For patients, the situation becomes complex. Before being operated in a private clinic or in a private division of a hospital, it is essential to verify the reimbursement methods with your insurance. Because within the same establishment, certain doctors remain covered by additional insurance, while others are no longer, depending on their acceptance or not of the proposed pricing model.
Some insurances now require a quote before the medical procedure. They then decide on the amount of the reimbursement, sometimes leaving part of the costs of the patient. A situation that strengthens uncertainty and complicates access to care in private sector.
Negotiations continue between insurance and doctors’ associations. Finma should make its verdict on the various pricing models in force in the coming months.
“It would take transparency on these prices”
Guest of the Forum program to react to this situation, Baptiste Hurni, president of the French -speaking section of the Swiss Patient Federation, first recalled that the additional insurance market is extremely unregulated. “It is an absolutely free market that is not controlled,” he said, stressing that insurers and clinics have all latitude to choose their partners, to the detriment of patients.
Faced with this situation, Baptiste Hurni pleads for more strict regulation. “Finally, there would be a transparency on these prices,” he said, regretting that current opacity prevents any objective assessment of responsibilities in this conflict. He also proposes that these prices be sanctioned by an independent authority and that insurance has the obligation to contract with patients, as is the case for basic insurance.
Finally, it alerts a problematic practice: the annual modification of the general conditions of additional insurance. “Many patients have additional insurance in order to go precisely in a clinic, but if this clinic has come out of the list, they have paid bonuses for years for nothing,” he deplores.
If the adviser to the Neuchâtel States acknowledges that an abuse control in invoicing is necessary, he warns against the risk of selection of risks by insurance. “It is extremely easy for additional insurance to take out a clinic that costs it too much,” he explains. The solution, according to him, lies in better legislative supervision in order to protect the most vulnerable part of the system: patients.
>> Baptiste HURNI’s details in Forum:
Radio subject: Anouk Pernet
Adaptation Web: Tristan Duke