EXPLAINED: How to see a specialist doctor in Switzerland without a referral
Switzerland has an excellent healthcare system, and the compulsory insurance allows access to a wide network of specialists — under certain conditions.
For many foreigners coming from countries with some form of nationalised healthcare — for instance the UK, France or Scandinavian nations — the Swiss system of private insurance carriers may be difficult to navigate.
Often, questions about what services the patient is entitled to under various forms of insurance available in Switzerland abound.
For instance: can you make an appointment with a specialist directly, or do you need your GP’s referral in order for the insurance to pay for the visit?
This is what you should know
Generally speaking, you can consult specialists without a referral from your doctor — unless your insurance policy states otherwise.
The compulsory basic insurance — KVG in German and LaMal in French and Italian — is quite comprehensive, and in principle also covers “unreferred” specialist visits, provided the doctor is officially recognised and not an unlicensed, back-alley practitioner.
However, there are exceptions to this rule.
In an effort to save money on notoriously expensive health insurance premiums, you might have switched to a cheaper model. If this your case, you are limited in your choice of physicians, including unreferred specialist visits.
These are some of the more restrictive plans:
Health maintenance organisation (HMO)
Under this model, policyholders are required to consult a particular HMO practice. Two disadvantages of this alternative is a limited choice of doctors and you also need a referral to see a specialist.
However, the benefit is a premium reduction of up to 25 percent compared to the conventional insurance.
Family doctor model
Your family doctor, a general practitioner, will be designated by your insurance company and will be in charge of all your medical treatment.
He or she will refer you to a specialist if necessary.
If you opt for this option, you could save 20 percent on your insurance.
If you choose this option, you have to call a telephone service and get a referral to a doctor or hospital.
This does not apply to medical emergencies and other exceptions, such as eye exams and annual gynecological check-ups.
Total savings could range between 15 and 20 percent.
Having one of the above policies doesn’t mean you don’t have access to specialist care; it merely means that you can’t choose the specialist yourself and must get a referral to see one.
What can you do to have a free choice of specialists with no referral?
As stated above, if you have a “regular” policy, with no service limits attached to it, you needn’t worry.
But if you have one of the cheaper plans and it is more important to you to be unencumbered in your choices of medical providers than to save money, then your only option is to switch policies.
Choose one that places no limits on the choice of doctors — both specialists and GPs — either through unrestricted KVG / LaMal, or by opting for an upgraded (but also more expensive) plans like supplemental, semi-private, or private coverage.
Aside from the free choice of doctors, these policies also offer more perks, including access to alternative medicine and private rooms in the hospital.
Remember, however, that you can’t switch insurance companies from one day to another. You can only do so at the beginning of a calendar year, and you must notify your current carrier of the change by registered mail by November 30th at the latest.
You don’t have to give reasons for the change, but you will need to present proof that you took out a new policy with another company.
And there is more
Even though you may have a free choice of specialists without a referral, keep in mind that your GP can be a good resource nevertheless.
This is especially true if you are a recent arrival in your area, or just don’t know which specialist is most suited to your particular medical issues.
In such cases, the family doctor can recommend someone you may not have been able to find yourself.