Requirements tightened Insurance company cancels treatments - even for the seriously ill
Groupe Mutuel is tightening its guidelines for the reimbursement of alternative medical treatments. Those affected sharply criticize the change and suffer as a result.
No time? blue News summarizes for you
- A 26-year-old woman with chronic pain is now only entitled to a maximum of nine instead of 18 medical massages per year from her supplementary insurance with Groupe Mutuel.
- Groupe Mutuel now requires a doctor's certificate for frequent use of alternative therapies.
- Insurance companies must ensure the effectiveness and cost-effectiveness of such services.
Insurance in Switzerland should make life easier for customers. Groupe Mutuel is now setting new standards for people who are dependent on insurance.
A 26-year-old woman from the canton of Fribourg has already undergone ten back operations and suffers from severe chronic pain. To alleviate her pain, she regularly needs medical massages. Until now, these were covered by Groupe Mutuel's supplementary insurance - a total of 18 sessions per year, which corresponds to one massage every three weeks, as SRF writes.
But the shock came at the end of June. Like all customers with supplementary insurance from Groupe Mutuel, the 26-year-old received a letter from the company. The letter states that if you make "excessive" use of alternative medical treatments such as massages, acupuncture or osteopathy, there will be restrictions on reimbursement. Or Groupe Mutuel requires additional proof, such as a medical report. This must prove that the treatments are really needed for therapeutic purposes.
False information on the phone
A Groupe Mutuel employee told the young woman on the phone that she would only receive a maximum of nine treatments per year. Regardless of whether a doctor's or therapist's report is available.
The difference to before is huge. Instead of every three weeks, she can now only go for treatment every six weeks. This has greatly reduced her quality of life, she tells the SRF consumer magazine "Espresso". She can also only work 50% and cannot afford the treatments on top of her premium.
"Esspresso" then asks Groupe Mutuel why the 26-year-old is being denied the "urgently needed" massages. Groupe Mutuel wrote: "In the event of serious illness [...] we will request a report from a doctor to assess this more precisely and, if necessary, cover further sessions." The woman had been misinformed on the phone, for which they apologize.
The procedure differs from insurance company to insurance company
The SRF writes in its report: "Services that are covered by supplementary insurance must be effective, appropriate and economical. These conditions have always existed, as the health insurance ombudsman confirms. How the insurers check these criteria varies.
However, according to the ombudsman's office, a report from a doctor or therapist is mandatory for the rejection of further treatments. This is the only way to check the criteria for effectiveness, appropriateness and cost-effectiveness.
Groupe Mutuel is therefore tightening the screw. Because more and more insurers are purchasing more and more alternative medicine services. This has become too expensive for the insurance company. Groupe Mutuel now only covers five to eight alternative medical treatments per year without medical evidence.
When an insurance company states that it will cover costs of up to CHF 5,000, this does not mean that insured persons can use up to this amount at will. The criteria of effectiveness, appropriateness and cost-effectiveness must also be met in this case. This also applies to Groupe Mutuel's "90% unlimited" model.
