Here is a simple explanation of the reimbursement system, including a short animated film that is easy to understand.
Reimbursement (third-party guarantor)
Under the Health Insurance Act, it is the patient who owes the medical fees and not your health insurer. That's why, after an appointment, your doctor, therapist or the hospital send the invoice to you.
You send the payment for the invoice to the party who sent it and submit the document to us with the adhesive label applied. We check the invoice and reimburse you for the insured costs less your own co-payment. The amount, date of transfer and account details appear right at the bottom of the first page of your benefits statement:
Direct payment (third-party guarantor)
Provided that we have contractually agreed a direct payment with a service provider (hospital, doctor, therapist or other), the service provider sends the invoice directly to us. We then transfer the outstanding amount to the service provider.
We then invoice you for your co-payment and the due uninsured amount.
Your insurance card contains all the important information about your insurance cover. It simplifies the flow of information between you and the service provider (hospitals, doctors and pharmacies).
You can use the insurance card to obtain medication at the pharmacy, for example. After checking your insurance coverage, we only invoice you for your co-payment and the due uninsured costs.
Everyday we receive around 55,000 invoices from clients, doctors, hospitals and therapists. Around 50% of these are received electronically, and we scan the remaining invoices centrally.
Please attach a pre-printed label to each invoice you submit to us. This, together with a bar code that is applied upon receipt, helps us to automatically assign the invoice to the right department. This in turn helps us to speed up the billing process.