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Doubled, too high or charged for no reason: Financial market supervisory authority criticizes medical and hospital bills.
Policyholders pay CHF 3.7 billion in premiums annually to health insurers and insurance companies for receiving semi-private or totally private treatment in hospitals. At least part of these 3,700 million does not correspond to any service provided effectively.
This is the conclusion of the Financial Market Authority (Finma) after extensive on-site inspections this year: services are billed twice, bills are above actual costs, up to 40 doctors claim fees in a single bill without justifying for what. In the case of identical transactions, the supplementary insurance is charged once 1,500 francs and once 25,000 francs.
Based on their analysis, Finma assumes a significant amount for the broader market that simply cannot be collected from premium payers.
Finma spokesman Tobias Lux says there is an urgent need for action: “We expect insurers to only pay benefits that are justified by additional benefits, which go beyond basic insurance and can be justified in this way in terms of price. “.
Legend:
Finma demands effective control of the insurance companies and the renegotiation of contracts with the treating hospitals and doctors. At least where it is necessary to obtain understandable invoices, says Lux.
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Lux cannot yet say how high the sum is for which no clear accounts are currently available. Finma is now investigating. But the scope is certainly not trivial. According to their analysis, Finma assumes a significant amount for the broader market that simply cannot be collected from premium payers. “
The Swiss Insurance Association takes note of the criticism. Spokeswoman Sabine Alder says: “The issue is known throughout the industry and supplemental health insurers have taken action.”
The billing model should be the culprit
But why haven’t supplemental insurers reviewed hospital and treating physician bills better in the past? “In order for them to carry out their control tasks, the invoices must be transparent. For this reason, the previous ‘total cost model’ for cost accounting is being replaced by transparent multi-service models, ”says Alder.
Legend:
According to insurance companies, the billing model is to blame for the non-transparent billing of treating hospitals and physicians.
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In private clinics in Switzerland, it’s easy to scoff at the fact that Finma is publicly criticizing. In this regard, however, Finma’s message is clear, says Guido Schommer, Secretary General of Private Clinics in Switzerland: “Everyone is aware that this will not be without consequences. From our point of view, it is clear: it should be possible to show additional services in a transparent way. “
This claim is legitimate, Schommer continues. “There will be more pressure in this direction from the insurer.” More pressure from insurance companies on hospitals and treating physicians to design contracts in such a way that transparent bills can be written.
Now politics must act. You can’t let the additional insurers handle it.
Actually something that should be taken for granted, criticizes the managing director of the Foundation for Consumer Protection, Sara Stalder. His foundation has long criticized supplemental hospital insurance as mere money-making machines. “Finma’s analysis has brought a scope that one could not expect. Now politics must act. You can’t let the additional insurers handle it. “
The Foundation for Consumer Protection requires that policyholders who have paid excessively high premiums for supplemental hospital insurance for years be compensated and that premiums now be lowered. Finma, as the supervisory body for complementary insurers, will ensure that the latter happens.
