Here’s how to check your medical bill

Santésuisse assumes that health insurers can save 3.5 billion francs per year by keeping medical bills under control. As Suva recently announced, by 2022 it had to reject 10 percent of audited invoices due to errors and inaccuracies, thus saving R90 million in medical costs after accidents. The insurers are primarily responsible for bill checking, but you as a patient can also contribute.

The doctor must provide you with a “detailed and understandable bill”. In it, it must provide you with all the information you need “to be able to check the calculation of the remuneration and the economic efficiency of the service”. Since January 1, 2023, the doctor must ensure “that the invoice is understandable to the insured and that, in particular, the nature, duration and content of the treatment are presented in an understandable manner.” Even if the doctor treats you for an accident, the law obliges her to make the invoice understandable, so that the insurer receives the invoice. The same applies if you have an accident or become ill during military or civilian service.

But it is a problem of understandability, because according to the Health Insurance Act the doctor must list the individual positions “coded according to the classifications in the respective Swiss versions issued by the responsible department”. The regulation is more precise here and specifies, for example, that the ‘treatment calendar’ or ‘services provided at the level of detail as provided for by the relevant tariff’ must also be stated. You can read what lies behind the individual positions on the Tarmed site.

However, you can check some points of your medical bill yourself without further training or medical expertise from Tarmed: for example, whether the reason for the treatment and the duration of the treatment are correct, whereby the doctor invoices the consultations in increments of 5 minutes. You can also easily check whether any medication packaging that has been charged for is the correct size.

If you see something on your medical bill that seems incorrect to you, you can contact the doctor directly. It may be that the invoice is actually correct or that an error is the result of an oversight. The doctor may not charge you for checking the bill. You can also request the bill directly from your health insurer or accident insurer. As the Federal Council writes in its message on the measures to control costs, the insurer “can and must subsequently make the necessary clarifications and corrections”. Finally, you can also contact the patient center, which can advise you on medical bills.

Finally, it is important that you check the medical bill before paying, if possible. You can also transfer the undisputed part and keep the incomprehensible items until you have clarified them with the doctor.

In order to check the invoice, you obviously need to see it. With the ‘tiers payant’ system, the hospital mainly sends the bill directly to the health insurer. You are entitled to a copy of the invoice; this has been legally established since January 1, 2022. If you violate this, you may face sanctions such as reimbursement of fees or a fine of up to 20,000 francs.

You are not entitled to a copy of the invoice if you are treated for an accident or if the billing is done through military insurance. You can only hope that everything goes well, because these insurance companies bill directly to the service provider.