Why Swiss Health Insurance Doesn't always work (and why I now Love the NHS)

WARNING: If you get bored easily, you probably won't want to read this! Contains detailed workings of Swiss Health Insurance (yawn)

I had a fairly successful appointment with my Psychiatrist yesterday and one of the things we discussed was my health insurance.

I may have explained it before (and can't remember which blog post it was in) but it's like paying car insurance - you pay a premium and have an excess.  The smaller the excess, the higher the premium. When you have resided in Switzerland for more than three months you are obliged to have health insurance.

This is all well and good, when you pay your premiums.  When you see a doctor or other specialist or have a blood test, anything, the bill is sent to you and you then send a copy to the insurer who then refund you the amount of the bill less 10%.  You then pay the bill.  Sounds simple huh?

My problem was about two years ago I got into arrears with my premiums.  I tried making a payment plan with my health insurer, A. They refused and kept demanding the amount I owed which was 3 months worth of premiums for myself and my boyfriend at the time (he paid the rent).

As a result of the arrears, they then stopped paying my medical bills.  So as a result, any money I had had to pay the medical bills and not against the arrears.  I asked for a payment plan again.  They refused.

Well, I thought, I will change insurers so that the new insurer will pay my medical bills, close off my old insurance and make part payments until the arrears are paid off.

You can only "leave" an insurer twice a year, by the end of June or by the end of December.  To cancel the contract, the insurer has to receive your cancellation a month before the end of June/December and this has to be sent recorded delivery.  They are Swiss - don't follow thse rules and your request is ignored.

I duly sent the letter, correctly and within the timescale.  Insurer A replied with a letter confirming the cancellation.  I then signed up with a new insurer, O,  who sent me the contract which I signed and returned. I started paying the new insurer from the January.

Insurer A kept sending me bills.  I telephoned them and said they had accepted my "resignation" and I was no longer insured with them.  They said it was not possible to change insurer because I had arrears on my account.  I asked for a copyof the letter and they sent me the original "acceptance of resignation" PLUS another piece of paper attached (which they had not attached before) which stated that you cannot change insurance when you have arrears on your account.  News to me. I wrote to them explaining their mistake and they didn't accept it.  Meanwhile, the debt kept mounting up, but at least the new insurer was paying my medical bills.

So, to insurer 2, O. I explained to them that I was not allowed to change insurers because of the arrears and the new insurer said because I had now signed a contract with them, I had to continue to pay them insurance premiums. Problem: I was now expected to pay 2 insurance companies.

Of course, this put me in complete panic and being in a pretty poor mental state these days with coping with stuff like this I decided to refer to Social Services.  Initially I saw the SW as part of the Psychiatric service and she investigated, telephoned people, contacted Ombudsmen etc etc on my behalf and what she discoverd was interesting:

1. The Old insurer is meant to write to the proposed new insurer to "allow" me to leave them.  Insurer A DID NOT DO THIS.

2. You are not allowed to be insured by 2 companies.  Both insisted that I pay them premiums.

3. Basically, what these insurers were doing is illegal.

Anyway, to cut a long  and boring story short (thankfully, you say!), My medical bills and health insurance are now paid for by the state, the debt has mounted up and I have been placed on an official Swiss debt register.

I was discussing this with my Psychiatrist yesterday as he has been trying to get hold of my SW with no luck, so he is going to talk to the Psychiatric service SW to review this whole situation again.  If I have to have any seriously expesive treatment then there is some State "governer" type for health insurance who will approve the treatment.

This has been going on for 2 years now and neither insurer will accept any responsibility and I feel the pressure of it all.  Luckily my doctor will keep treating me, I can still see my Psych (although I have reduced the number of appointments) and my pharmacist will keep supplying me with medication as they all agree I need continued support and treatment.  This is where it is handy to have a more personal relationship with professionals (which somes with living in a small village) and they have been great.

But I don't half miss the NHS.  I will never complain about them again.  Well, until I am back into the system when I return to the UK.

I'm Back

Wow, didn't realise how long it was since I last posted.
OK, so last week I went to the UK for a week.  Before this, a couple of things happened here to really upset me.
First, I found that all the Norway stuff, NOTW and Amy Winehouses death REALLY touched me.  I was getting all ranty about right and wrong, crying and feeling generally shit about life and the world we live in.  This culminated in an arguement with my exes sister in a bar about how wrong she was when she spouted that Amy Winehouse brought it all on herself as she had all the support she needed and didn't do anything about her addictions.  I argued that addictions are complicated and she was compelled to keep her drugs and alcohol lifestyle because of her addicitions which she couldn't really help at that stage (bear in mind my exes sister went out with a serious drug addict).  Anyway, i stormed out the bar in a rage and came home and cried and cried.  She had also said that people "like that" can help themselves where as people with cancer can't etc. etc.  So I went home and sent a ranty email to my psychiatrist, as  follows:

Hello,

OK, BILLS – the situation is this.  I am now with the Sozialdienst – Herr A, so anything he needs to know, you can tell him. He has been really helpful and I had 2 appointments with him last week.  I am back with Avanex – they paid my hospital bill for March but anything 1^st Jan – 30^th June they will not pay until the arrears are cleared (hence I am back to the same situation as 2 years ago).  Herr A is trying to get agreement that they will pay the bills.  However, if they won’t pay them, I can offer 100chf a month to clear the arrears of medical bills (i.e. yours).  Could you plese let AKCM know this so they don’t register with the Betreibungsamt. I will also need Einzahlungscheins to repay.

Me -  was good, now not so good.  I have been generally OK but over the last two weeks fighting dropping lower and lower.  There is so much happening in the world outside Wengen that I can’t understand and frightens me and is making me anxious and upset (Norway, Phone Hacking, Amy Winehouse’s death).  In fact, I have just left RBar after an argument about Amy Winehouse which upset me as apparently she had lots of help and is still dead therefore it is her fault, it’s not like she had cancer anyway.  And this comes from J’s sister who went out with e drug addict from L for many years (M in case you don’t already know him).  Walked home crying – why don’t people get it that addiction for some people is a real problem no matter how much help they get? I feel so worthless and pathetic that I only have depression and should just “get over it”.  Maybe I should, but these last few days I have felt so low without explanation and I just can’t get it across to people.  And yet, for the week before I was on top of the world and reading self help books and making plans.

My schoolfriend wants me in England this weekend for her mother’s birthday.  Her mother is like a second mother for me (ex-nurse too) so she has paid for me to go.  Maybe it will do me some good to get off the mountain for a while.

I thought I was doing so well – OK, no job ( I didn’t get that job last month and a couple of others I really thought I was in with a chance of rejected me) – all I am doing is dog-walking for a friend of mine who has returned to college but that’s only as a friend to get me out of the house and to be doing something rather than nothing.  I see Dr A on 4^th August when I come back from the UK.

I know I am rambling about nothing, but I don’t want to book another appointment until I have paid your bills.  But I am just so upset at the moment.  I am still not sleeping (unless I take Seroquel) which is not helping but I really feel lost and lonely and stupid and useless.  And I have lots of questions for you – I have been reading too many books about how Psychiatrists are all influenced by Big Pharma and that the brain chemical theory is all a myth so I feel even more stupid and useless because I feel the antidepressants do help me in some way, but maybe it is all in my head because you are conning me (according to them). I don’t know what to believe anymore, all I know is I don’t feel right.  And I don’t understand it because I felt good for a while – full of plans and ideas and a way forward.  But today I don’t.  And speaking to people they just make me feel worse because apparently I am in control of getting help and therefore have no right to feel the way I do.  After all, it’s not like I’ve got cancer, is it?

Sorry to take up your time, I am writing this when I am feeling quite low and confused.

Me

Actually, this is the first time I have rad it back and maybe it doesn't seem so bad that I emailed him as it was a definate cringe factor for me that I had sent it.  Anyway, luckily he was out of the office until 4th August.  However, when I was on the train to the airport one of his colleagues phoned me but I couldn't really speak as I was on a train full of people and didn't want to discuss my mental state of mind so I just said I was "fine" (?!).

I'd also had a rant on facebook which my exes sister saw because she "liked" one of my comments.  I take that as her way of apology.  she has been super nice to me since I came back from the UK.

So when I was away I demanded that my ex stay at my place to look after our cat (my cat now).  Which he did.  I filled the fridge full of food as it was a bank holiday and he was working stupid hours for the August 1st celebrations.  When I came back last Wednesday, the studio was in a TIP - dirty, messy, his stuff everwhere and NO FOOD.  I'd been up since 5 a.m., got back at 4pm and was not best pleased.  To be fair, when he saw me (I went straight to the bar after shopping) he did apologise about the mess but I was soooooo cross I couldn't even speak to him.  He came round to my flat many hours later to "pick up his stuff" even though I had told him not to and he ended up staying the night.  I think he was wanting a bit of sex (as to complicate the matter he is now my fuck buddy) but he didn't get any as I am on.  Anyway, two days later he came round again during the day for a "shower" and I am sure sex but I lied and said I still had my period as I just couldn't be bothered.  And then he wants me to sort out HIS health insurance, tax, debt in the UK etc.  I just keep saying yeah I'll do it and keep leaving it.  WHY do I keep enabling him?

So the UK - it was FANTASTIC! I went to see my schoolfriend whom I have known for over 20 years (god I sound old).  She paid for my flights so I could be there for her mum's 70th birthday which was a lovely day.  Her mum is like a second mum to me and it was great to see her and feel loved and cared for.  Anyway, E (my friend) took me out to see her social life and I met some of her new friends who are lovely. They made me feel so welcome.  I didn't go out every time she did because I was knackered from the Seroquel, but I slept better, ate better and felt better for the week there.  In fact, her friends were begging me to stay and not go home by the end of the week.  For the first time in ages I felt included and wanted and loved.  I can't leave this bloody country until all this health insurance thing is sorted out.  Even though I think I can return to the UK and get a decent job with more money to pay the debt back quicker, I don't think I am allowed to leave the country permanently with a debt.

So now I am back home.  And I have dropped into a hole again.  I missed my doctors appointment on the 4th as I was asleep so have rescheduled.  But I feel lonely and very sad and dwelling on stuff. I am usually back on Twitter, facebook and blogging but I just haven't felt like it.  I've been drinking a lot too, which doesn't help. I am content with life here but it's not enough.  And then I think, if I go back to the UK, is it just another distraction, major life changing thing that I tend to do when life gets too much which doesn't actually solve anything?

Confused.

Health Insurance (again)

So I have come full circle.  The problem started with my health insurance 2 years ago when I fell behind with the premiums.  So I changed insurers as Insurer 1 stopped paying my medical bills until I had caught up with the arrears.  Insurer 2 were happy to pay my medical bills so I continued to pay the new insurer and get my medical bills paid.  I thought I had "resigned" the contract with insurer 1.  But no, I was not allowed to change insurers with arrears outstanding and they would not accept a payment plan from me although I offered this on at least 3 occasions. Insurer 1 should have informed insurer 2 that I could not proceed with a contract with them, but they didn't.
Insurer 2 then said because I had signed a contract with them also, that I had to pay them as well.  So in effect, I would have t pay 2 health insurers which there was no way I could afford. Insurer 1 kept billing me.  I kept telling them that I was no longer insured with them, so to stop billing me.  I saw the social services, but he misadvised me, so all the while insurer 1 kept registering my non payment as a debt.  I then had the government debt people chasing me for money which I didn't believe I owed and couldn't afford anyway.
Finally this year my psychiatrist referred me to the social worker based in the psychiatric department (no doubt he wanted paying too!) and she started getting involved.  Basically insurers 1 &2 were acting against the law.
Following so far?
Another three months down the line, insurer 2 started issuing refunds to me, although I had specifically said to pay back to insurer 1.  Of course, they weren't going to do this as that would show liability.  In the meantime I was referred to the normal social services department as my social worker had done all she could within her remit.
Hence I have now received another letter from insurer 1 repeating what I was told 2 years ago.  "We will not pay your medical bills untill all arrears have been paid".
In effect, this means I can no longer afford medication, I cannot afford to go to my GP, I cannot afford to go to my psychiatrist.  Normally after I have visitedeither of these /collected medication, I am billed.  This gets sent to the insurer, who then refunds me the total bill less 10%.  I can then pay the bill with a small contribution from myself so that it is paid in full.  I can negotiate part payment, but still have to pay my insurance premiums, so it is one or the other.
Basically, I'm screwed.  After half an hour of crying this afternoon I put my energies into sorting out exactly which bills were still outstanding.  I have an appointment with social services in the morning and they know that they have to deal with the insurance companies on my behalf as I am not mentally capable any more of communicating with them - it's too much and I don't always know the words to converse in German. 
I am also waiting for my unemployment benefit (3 months now) so I phoned them today.  They told me they still need more paperwork.  Would have been nice if they had written to me to let me know what was missing, so I photocopied every job related bit of paper from the last two years and sent it to them with a covering note to say if there was anything further missing all they have to do is look up my file from last October from when I last signed on and it will all be there.  Of course, being Swiss that probably won't be good enough and I will have to do the rounds of all my employers in the last 2 years to get copies of paperwork which the unemployment office ALREADY HAS!
Frustrated? YES. Upset? YES. Skint? YES (i have about five pounds to my name right now).
I know the meeting with social services will be awful tomorrow because I will get hysterical and cry because I can't take the pressure any more.  It's all too much.

Progress

I feel bad.  Very bad.
I've been feeling (up until now) pretty stable, not unhappy, able to cope.  However, a couple of things have been happening which I think have contributed to my mood suddenly skydiving.
First - ex boyfriend.  He split up because he said he wanted to be on his own.  Then he said a couple of weeks ago that he had never needed anybody (and although I don't want to feel needed, it's still hurtful that he doesn't need me in his life).  Now he is saying he is lonely.  Oh, and for some reason I still keep sleeping with him.
Second, I just found out that 3 and a half grands worth (CHF) of bills DID NOT get processed by the bank at the beginning of April.  And they didn't even send me a letter to tell me.  So I came back from holiday thinking the bills had been paid and oh look, I've done well managing my money and have enough to last me two months, which has now been spent on...well....living costs. So I am again behind with my psychiatrist bill and at the moment am in limbo between two health insurers so have no idea who is insuring me and who is paying my doctor's bills.
When I found out about the non-paid bills yesterday I really tried to not obsessively think about it.  I tried to do what that patronising prick Eckhart Tolle tells me in The Power of Now to just live in the situation. So I tried to distract myself but there was this little voice in the back of my thoughts repeating "FUUUUUCCCCKK" no matter what I did.  I disassociated from my feelings to try and cope.  Didn't work, the voice was still there. So I took some Seroquel to calm the voice down.  Promptly fell asleep for an hour which pissed me off as I haven't been sleeping properly at night for ages and didn't want to mess up my sort of routine.  (I was awake until at least 2 a.m. so yet more Seroquel to help me sleep).  Woke up this morning feeling generally low, lethargic and like I wanted to cry (and haven't been able to all day). Forced myself to get dressed and go out into the village (I needed some shopping and to pick up a prescription for Naltrexon) and found that I was feeling a bit disorientated and anxious about all the people.  Picked up my prescription and had a really nice chat with my pharmacist (she is a star and orders my drugs on emergency many times as I forget to reorder in time).  She asked me if I was living somewhere new as she had seen me carrying shopping at the other end of town.  I told her me and J split up in February, which she didn't know (her boyfriend was J's boss).  Anyway, she split up with her boyfriend (which I knew about) - he was 45, they had been together 20 years and he, like J, just turned round one day and said he didn't want to be in the relationship any more.  So there we were, in the middle of the pharmacy, bitching about men and mid-life crises.  But she said I looked better and although I felt like crying (which she kept apologising for) it was more because she was being so kind about it and not telling me crap like there are plenty of fish in the sea etc, etc.  She said we could meet up for a soft drink (she knows I have an alcohol problem) and that I can phone her any time.  We were both of the opinion that it can be a bit lonely sometimes and the thank goodness for our cat (mine)/dog (hers) to help us through.  Oh, and men are crap, pathetic little babies that can't deal with real life.  (Bit hypocritical on my part I guess).
Anyway, am at home now, a friend of mine will be on fb later to talk about not drinking (again) and hopefully remind me of the shame of alcohol.  I managed today all right but it is hard.  Still, am at home now and no alcohol in the house so as long as I stay in, I can get through today sober.
Doctor (GP) appointment on Wednesday, need to make another Psych appointment soon (when the bills are paid).  Still no job.