R200,000 in hospital bills: how a room upgrade in Hirslanden became torture

Walking to his mailbox has become a burden for Noah (not his real name). The medical bills have been coming in for months, each time reminding him of the most difficult time of his life. About the time his mother was treated at the Hirslanden Clinic in Zurich after a cancer diagnosis before she died. A time he does not think back on with great pleasure. Not just because of his mother’s death.

In November 2022, Noah’s mother lost her battle with cancer. And bills like this are still coming:

Invoice amount: CHF 22,704

Services: no information

Noah doesn’t know how many bills will follow. No one can give him any information. All he knows is that every bill opens old wounds.

Noah says:

The difficult time begins in the winter of 2020. Noah’s mother is diagnosed with cancer. After a stroke in September 2022, she had to be admitted to the Hirslanden Clinic. Her husband died early and she is supported by her two sons.

She spends the first eight days in the semi-intensive care unit. They then wanted to move her to the normal ward. Due to her poor health, the cancer patient would like a single room. Because she has semi-private insurance, she has to pay extra for a single room.

Cost: 1280.- CHF per day.

This is where the problem with the bills starts.

The additional room charges will be charged to the family from the date of arrival. This means: Noah’s mother also has to pay retroactively for the eight days that she has not used, according to an invoice that Watson has received:

The price for an upgrade is within the usual range, says Mario Fasshauer, manager of the Zurich patient center. But he criticizes the retroactive billing. “If this is actually the practice, it would be extremely unusual and it would be appropriate to investigate the situation further,” says the head of the contact point, which supports patients in clarifying legal questions.

The Hirslanden Clinic writes that this is not common and that only services actually received will be charged. For data protection reasons, the clinic is not allowed to provide information about the specific case.

For Noah, however, this was just the tip of the iceberg.

In the winter of 2022, Noah’s mother will be transferred to intensive care. They then want to move her to a shared room, although she would like a single room again. “My mother called me that day, completely upset and in tears. She would be touched if she didn’t immediately leave a deposit of about R20,000 for the single room at the reception,” says 33-year-old Noah.

He had already offered the clinic in advance to pay the requested down payment. Apparently no one remembers that.

“My mother was connected to numerous tubes at the time and had terminal cancer. She had difficulty speaking and could only move in a wheelchair.” The idea of ​​his mother having to pay the bill at the reception in this condition still angers him today.

Noah immediately drove to the clinic and paid. “The deposit had to be made the same day,” says Noah, who “felt under pressure.”

Mario Fasshauer, manager of the patient center in Zurich, knows of no comparable case. However, he says the shortage of trained staff often creates communication problems between patients and staff.

How this could have happened in the case of Noah’s mother remains unclear. The clinic cannot respond to the specific case.

Since his mother’s death in November 2022, he would be happy if the clinic would send him the bills as soon as possible.

“I literally begged accounting to send me all outstanding invoices so I could pay them immediately.” But so far no one has succeeded.

The problem: Clinic Hirslanden uses a so-called affiliated physician model. The attending physicians treat patients in the clinic, but are not directly employed by Hirslanden. This means that you work on your own account – and bill yourself accordingly.

Roughly estimated, the stay and treatments cost the family 200,000 francs. But the clinic has no overview of how many bills are still outstanding. The fact that the invoices are confusing for a layman because the services provided are only shown with a code does not make it any more bearable for Noah.

A question to the patient center shows that such cases are not uncommon. The fact that medical bills are difficult for patients to understand is a problem. “Patients are the best control in the healthcare system, but because many people cannot understand the bills, this control mechanism is limited,” says Mario Fasshauer.

The time of full invoicing for a case depends on many factors, writes the Hirslanden Clinic. Only part of it is within their sphere of influence. It may happen that fees are sometimes charged directly by the partner doctors. The contents of these invoices are then beyond the hospital’s knowledge.

Noah also has bad memories of the treating doctor model for another reason. The doctors were poorly informed and did not communicate sufficiently with each other. “For example, the urologist once wanted to stop taking the blood thinner, but the neurologist strongly advised my mother against this to prevent another stroke.”

According to the patient center, the reason for this is the treating physician system. The clinic offers bed and hotel services only; the treatment is the responsibility of the treating physicians. The problem: These physicians’ practice systems are not linked to the clinic system. “Unfortunately, there is still no electronic patient record,” says Fasshauer.

The federal law on electronic health records (EPDG) came into effect in 2017. But implementation is difficult. As of August 2023, only about 25,000 patient files had been opened in Switzerland.

There is currently no closed network between the IT systems of the various practices and hospitals. This lack of integration means that important patient information and medical data are often only available in fragmented and isolated form. It cannot be ruled out that this can lead to negative effects and even complications.

In certain cases, medical expenses not covered by insurance can be deducted from taxable income, but only within three months of the date of death. In the case of Noah’s mother, this period has long since passed.

“I can no longer deduct invoices that were sent or followed after submitting the tax return. I checked with the Tax Authorities,” says Noah. The IRS also contacted him with questions about the undetailed medical bills.

According to him, the affiliated physician system for self-payers is not well thought out at all. “You don’t know in advance what will happen to you. Normally this is all done through the health insurer. This way you are not constantly confronted with the death of a loved one.”

He and his brother have no financial planning certainty until 2027. Within the legal framework, doctors are allowed to invoice for services performed up to five years ago. “I only recently received a bill for 2021 – my mother’s previous outpatient cancer treatment.” Noah says, “I’m convinced there are many surprises coming our way.”