Childbirth in Switzerland, dialysis paid in cash in Morocco, detainee who demands paternity leave… Every year, social security is faced with contentious situations. Mediation by Assurance Maladie settled 82% of the 50,000 disputes received in 2021.
After having given birth in an emergency in Switzerland, Madame G. was forced to pay a bill of 6,384 euros, with social security only covering 917 euros. After a complaint with the Social Security mediation, she managed to obtain a reimbursement of 4798 euros. Madame V., a magician on maternity leave, contested the amount of daily allowances calculated by Social Security and obtained a reminder of more than 10,000 euros. Mr. S., who had been refused reimbursement for dialysis sessions carried out in Morocco and paid for in cash, managed to get his expenses reimbursed. As for a former prisoner, father of four children including a newborn, who had been refused compensation for his paternity leave for lack of sufficient duration of affiliation, he too won his case. And these are just a few examples of the approximately 50,000 disputes settled at 82% by the mediation of Health Insurance in 2021, revealed in its activity report published on Friday.
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Relying on a network of 107 local mediators distributed throughout the territory, the Mediation of the Health Insurance has the function of “promote access to rights and care» et «improve the quality of service provided to users“. Almost all of the referrals recorded (99.4%) concern users, 0.5% healthcare professionals, and 0.1% employers.
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Just over 18,200 cases relate to reimbursements, a figure up 35% following the increase in work stoppages which has led to a major volume of daily allowances paid since 2020. Especially since the derogatory procedures put in place place during the Covid have complicated the situations usually dealt with by health insurance funds.
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Some 14,000 other referrals relate to the difficulty of finding a treating doctor, or 28% of the overall volume of files. Even if it is in decline, the assumption of medical transport costs is also a frequent subject of dispute, patients often unaware that their reimbursement is subject to a prior agreement.
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