When you took out LAMal health insurance, you were probably offered a choice of different plans. Many people opt for HMO or Telmed because the premiums are between 10 and 20 per cent cheaper. What isn’t always clear at the time is what this actually means in practice when you need to see a doctor.
Under the HMO model, you must go via your GP before seeing any specialist. Under the Telmed model, your first call goes to a medical call centre, which decides whether you need to see a doctor and where. If you skip this step, your health insurance provider may refuse to reimburse you or reduce your cover. The discount on your premium comes at the price of having to follow a set procedure.
It happens quite often in the summer. Someone notices something on their skin and calls the dermatologist straight away, without thinking to see their GP first. Someone else wants a routine check-up and books an appointment directly with the specialist. The bill arrives as an out-of-pocket expense, and that’s when the surprise hits. The exception is a genuine medical emergency: if you go to A&E or call 144, the rules don’t apply. But the definition of an emergency that you have in mind and the one applied by the health insurance funds don’t always match.
If you’re not sure which model you have, it’s listed on your policy, or you can ring your insurance company and ask them directly. It’s worth checking before the summer, not after.