The Sanitas health fund contests the prices charged by most private clinics in Geneva.
20min/Michael Scherrer
The rag is burning again between health insurance and Geneva clinics. This time, it’s Sanitas who kicks the can down the road. Since October 28, it no longer reimburses additional treatments (excluding basic insurance) provided in the four largest private establishments in the canton: Grangettes, La Colline (both Hirslanden group), Générale-Beaulieu and La Tour. In the latter case, the contractual termination is older: it dates back to the end of June.
“I discovered it on Sunday in the Grangettes emergency room,” says a Geneva woman who suffers from heart problems. “The clinic advised me to go to HUG, I refused. She finally agreed to take me into the common division.” The patient is “scandalized”: she claims to have never been informed of the situation by Sanitas.
“At that price, I wouldn’t expect that!”
She thought about changing insurance, “but at my age, with my pathologies, the funds put reserves for LCA insurance. So, I’m stuck.” She specifies that she pays Sanitas “nearly 1,800 francs in monthly premium in total, for Lamal and complementary insurance. At that price, I expect to be able to be followed by my own doctors!”
A new kind of litigation
The problem is there. Previous conflicts (read the box) directly opposed clinics and insurers. Here, Sanitas is after the Geneva doctors — and only them, the Vaudois are not concerned. She contests the pricing system they use, considered too expensive and contrary to the rules of Finma (the Swiss financial policeman).
Sanitas spokesperson, Christian Kuhn explains it as follows: “Supplementary insurance (LCA) only covers additional benefits which are added to those of compulsory health insurance (Lamal). Approved doctors in the canton of Geneva bill according to a pricing system which is based in principle on individual medical services which, according to Sanitas, are already partially covered by the basic services of compulsory health insurance, or which cannot be clearly distinguished from these services.”
Sanitas wants to make doctors bend
In short, the fund believes that these practitioners operating in private medical establishments in Geneva are overcharging. He thus asked the Association of Physicians of the Canton of Geneva (AMGe) “to apply a pricing system consistent with regulatory requirements”. Alas, “despite several rounds of negotiations”, no agreement has yet emerged.
“Taking clinics hostage”
The affair is a complete bag of knots, the AMGe observing “that there has never been a pricing agreement or invoice model between Sanitas and the AMGe”. According to Antonio Pizzoferrato, the association’s general secretary, the situation is akin to taking the clinics hostage. “The fund tells them: we no longer recognize you, because the doctors don’t bill the way we want.” In short, the insurer “claims that clinics impose rates on doctors (who rent their premises), which they cannot do”. Corollary: patients “are directed towards HUG, which contravenes free competition”.
For the moment, Christian Kuhn specifies that LCA policyholders can continue to receive treatment in the four non-contract clinics. Lamal services are reimbursed. As for additional ones, they must be the subject of an estimate provided by approved doctors. Sanitas then decides to pay them or refuse them.
The solution from Geneva doctors
The Geneva doctors’ association has a solution to get out of this situation. Two years ago, “Finma said that the pricing system needed to be more transparent. We have developed a new invoicing system with Groupe Mutuel, Swica and Assura, explains Antonio Pizzoferrato. Assured to apply it since the start of the school year, it will come into force with the two other funds from January 1. Our solution is this. In the spring, Finma will check it and make a decision. If she deems it adequate, it will be perfect. Otherwise we will have another problem.”
Since March, a series of conflicts
The conflict between insurance companies and Geneva private clinics began in the winter of 2024. As of March 1, CSS refused to cover treatments carried out in the private and semi-private divisions of Grangettes and La Colline. Helsana, for its part, had a dispute with the Grangettes clinic alone. This double dispute ended on May 1. On this same date, it was the Mutuel Group which opened hostilities with the Hôpital de La Tour. Care of its patients was only restored on October 1. Finally, since September 2, Helsana has stopped reimbursing the care provided in this same establishment in Meyrin. This case is not resolved. In all of these situations, clinic prices were at issue.
The position of the Grangettes
Director of Grangettes, Véronique Lambert “strongly deplores” the situation: “as it stands, certain patients benefiting from supplementary insurance with Sanitas no longer have the choice of their doctor or their healthcare establishment”. She indicates that for certain treatments, there is “a certainty”, and not a risk, that the clinic will not be funded. In these cases, “we cannot take care of elective (editor’s note, non-urgent) patients”. Situations are nevertheless analyzed “on a case-by-case basis”. For Véronique Lambert, this is a French-speaking problem linked to the requirements of the funds “concerning tariff structures and their compliance with Finma recommendations”.
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