What is Sympany doing to counter rising health costs?
The rise in health costs is relentless. We know that many policyholders are finding it increasingly difficult to pay their premiums. Sympany is working hard to counter the rise in health costs and premiums by joining forces with industry association prio.swiss and other partners.
We use strict invoice verification procedures to identify invoicing errors. Thanks to digitalisation, these are now more efficient, comprehensive and cost-effective.
Invoice verification prevents unjustified payments, thereby making an important contribution to curbing rising costs. This verification process carried out by health insurance companies results in premium savings of around CHF 3.5 billion for policyholders.
► Tip: You can also make an important contribution by checking your medical bills. You can find out how to do this on the page Checking medical bills made easy. Please let us know about any discrepancies – we’ll take care of them. Go to contact form ›
The charges applied in the healthcare system are the result of regular collective bargaining between health insurance companies and the service providers such as doctors and hospitals. In its negotiations with the service providers, Sympany is committed to ensuring that services are provided efficiently and that charges and prices for treatments represent value for money. In many cases, industry associations such as the RVK or industry service providers such as santéservices handle tariff negotiations on behalf of numerous health insurers. They ensure that the interests of premium payers are fairly represented.
►Further information: What if tariff negotiations for supplementary insurance break down? ›
Our industry association prio.swiss is also involved in the policy for fair tariffs, flat rates and medication prices to avoid misguided incentives being created within the healthcare system while maintaining the high quality of healthcare provided in Switzerland.
Sympany has a lean structure: with around 560 employees and 267,000 policyholders with basic insurance cover, we are among the top ten largest providers in Switzerland. These employees also look after our supplementary insurance policyholders and corporate customers. Streamlined decision-making processes, efficient systems and largely digitalised and automated processes enable us to focus on what matters most: our customers.
Effective outsourcing and productive partnerships also keep our administrative costs low. Partners and associations such as prio.swiss, RVK and santéservices handle some core administrative tasks (such as tariff negotiations, invoice verification, insurance medical advisory services and IT services), meaning that we and other health insurers do not need to handle each negotiation separately or introduce technical solutions.
For quite some time, Sympany has predominantly processed invoices and receipts automatically upon submission, triggering reimbursements. Over the past few years, we have automated many other processes and tasks that previously had to be carried out manually – which took longer and resulted in more errors.
Digitalisation is also helping us to offer our policyholders a better service. Customers can now make many changes themselves, for example to their personal data or insurance cover, in mySympany. The changes are then transferred automatically to our database and new policies are sent out.
Artificial intelligence (AI) has also proved its worth at Sympany: Our voicebot answers calls, understands customers’ enquiries and forwards them to the appropriate team for processing. Our policyholders receive immediate answers from our chatbot: it is trained on an ongoing basis, enabling it to respond to many queries itself.
The insurance industry suffers losses as a result of unjustified benefit payments – particularly as a result of benefit payments fraudulently obtained from health insurers. Even if there are only a few cases that involve abuse of the healthcare system, these must be rigorously investigated and punished. Abuse and fraud must not be at the expense of honest premium payers.
In order to keep premiums as low as possible for all policyholders, our unit for combatting insurance fraud carries out checks. This ensures fair cooperation between service providers, health insurers and policyholders.
Modern technologies such as artificial intelligence have made it easier to forge receipts. In individual cases, invoices are also submitted to multiple insurers or for different insured persons. The BVM intervenes in the event of forgery of invoices or multiple submissions. To also help detect systematic abuse, Sympany regularly exchanges information with other insurers.
If a suspicion is confirmed, we will file a criminal complaint and terminate the insurance policy, where possible. If there is suspicion of abuse by service providers, we inform the competent authorities and, where necessary, also file a criminal complaint.
► Tip: Check your invoices carefully too. In this way, you will help to identify errors and possible cases of abuse at an early stage. If you have any suspicions, you can contact us at any time by email at E-Mail.
Sympany is committed to high-quality, low-cost basic healthcare. It is a joint owner of Sanacare, which manages group practices.
All of Sympany’s alternative insurance models offer affordable and professional primary care. Insured persons receive medical advice and treatment at one of the contact points, which vary depending on the model. These so-called managed care models contribute to cost savings. This means that policyholders receive discounts on their premiums within these models. How Managed Care models work ›
Sympany strives to be a fair and reliable insurance partner for its customers when they fall ill. For example, Sympany supports its customers by contributing to preventive measures, such as vaccinations, check-ups and courses or activities in keeping with the principles of getting fit (recognised health-promoting courses such as smoking cessation, back training, nutritional advice) and staying fit (gyms, sports clubs, sports associations).
