As a medical institution, SGK is required by the supervisory body santésuisse/SASIS to bill the services it provides, in line with the Health Insurance Act (KVG), as follows.
Billed to the health insurer
- General practice
- Specialist medicine such as cardiology, dermatology, surgery
Explanation
Here too, there must be a medical indication. If, for example, a patient wants a CT scan or laboratory tests that the doctor does not consider necessary, this becomes a private service.
Billed to the health insurer AND as a private/self-pay service
Treatment of chronic illness and general health complaints
Explanation
Consultations are billed to the health insurer up to the TARDOC time limit. Time may be extended with, for example, an examination where applicable. Basic laboratory tests are usually billed to the health insurer; special laboratory tests and treatments privately, after you have been informed of the costs.
Consultations are billed to the health insurer up to the TARDOC time limit. Time may be extended with, for example, an examination where applicable. Basic laboratory tests are usually billed to the health insurer; special laboratory tests and treatments privately, after you have been informed of the costs. The time limit is about 90 minutes every 3 months. Consultations are usually billed as 30 minutes to the health insurer and the rest as a self-pay service.
If this consultation rule applies to you and you do not agree with it, please tell the doctor. Your consultations will then be billed exclusively under the KVG. This means you forgo longer consultations once the time limit has been reached, and you may need to come to the practice more often.
Self-pay services only
- Check-ups, sport and lifestyle optimisation, Blood Tuning according to Strunz from the 2nd consultation
- Treatment by naturopathic doctors and therapists
- Holistic therapies and assessments
- Conventional diagnostics and therapy without a recognised indication
- Iron infusions without cost approval from the health insurer
Explanation
As part of so-called triage, the first consultation with a doctor at SGK is a necessary medical service and must therefore be covered by the health insurer (tariff protection, Art. 44 KVG). At this consultation you are informed of the expected costs and of any steps that may be needed for costs to be covered, such as obtaining approval from the health insurer's medical examiner.
Even for holistic indications such as heavy metal exposure, and even when treatment is successful (!), we cannot expect costs to be covered, as this problem is NOT recognised by conventional medicine or by medical examiners.
What do health insurers cover? Less and less!
You need to rethink. Health insurers are there to cover the major risks of conventional medicine – and that is a good thing. Thank goodness this still works very well here in Switzerland. On the other hand, we have to let go of the sense of entitlement: "I pay premiums, so I want something for them!" We must be increasingly willing to pay for our own health and make our own contribution to our personal well-being.