The last few patients are simply changing their health insurance model. And many want to save some money with the telemedicine model. A telephone consultation should be made before each visit to the doctor. However, those who do not comply may face a larger bill in a short time.
The consumer protection health insurance fairness check examined insurance regulations for 2023 and found: Assura, Concordia, Helsana, Swica and Visana are threatened with extremely expensive sanctions for the first violation without warning. It doesn’t seem to matter whether the breach was accidental or not.
The problem: Consumer protection relied solely on contractual terms – not actual practice by insurance companies. Now they’re fighting back.
Health insurance companies deny claims
Swica, for example, contradicts this: “Sanctions can be” formulated as “and applied with a sense of proportion,” says one spokesperson. In principle, anyone who chooses an alternative insurance model must comply with the model’s specifications in order to be eligible for the discount. Templates are communicated “openly and transparently” both on the website, in the brochure, and through advice.
Swica is therefore unable to understand consumer protection claims. “What exactly should not be transparent about this,” the spokesperson said. he continues. At Swica, about 20 percent of customers trust a Telmed model.
Concordia is also defending itself against the allegations. The insurer takes action according to its own knowledge only after the third reminder. As a result, customers are transferred to the normal compulsory health insurance model.
Due to regulations, Concordia cannot react in any way after the first violation. Sanctions are only applied if the insured fails to fulfill his obligations without any excuse.
advice works
Helsana also, according to her own statements, does not scold her customers without warning and from the very first violation. “We’ve found that the warning to follow the rules in the future is very effective,” a spokesperson told Blick. Helsana therefore openly denies the allegations. Sanctions will only be applied if “proportionality is taken into account”.
Visana points out that the consumer protection control is not correct. Visana is also accommodating and fair to its clients when it comes to Telmed models. “Any claim to the contrary is completely false,” says a spokesperson.
The health insurance association Santésuisse is not aware of any particular circumstances in which health insurance companies have approved the initial breach without warning. “Health insurers are practically bona fide,” media spokesperson (48) Matthias Müller tells Blick.
Knows consumer protection cases
Consumer protection has information about concrete events. “That’s why we put the issue in the first place,” says boss Sara Stalder. For fairness check, contract conditions of various insurance companies were evaluated using artificial intelligence.
Stalder acknowledges that health insurance companies may be more compliant in practice than what is stated in the contract terms. “You can be more accommodating with good customers.” Consumer protection therefore demands that this goodwill be included in the terms of the contract.
Unlike the competition, Assura health insurance company verifies the information provided by consumer protection. “Under our terms, the refusal to bear the costs of services is valid from the first breach,” a spokesperson said.
But even Assura shows goodwill: They don’t refuse to bear the costs up front. Instead, it gives its clients the opportunity to submit the required documents later. But there is nothing in the terms of the contract.