In Switzerland, direct claim settlement referred to as the "tiers payant" system.
The tiers payant (TP) system is the secondary, less widely used health insurance billing system in Switzerland (behind the indirect claim settlement system).
In the direct settlement model, the doctor, pharmacy or other healthcare provider sends your bills directly to your health insurance provider. Your insurer reviews your bills and pays the healthcare providers directly. So the doctor or pharmacy is paid by your health insurance provider without your involvement (“payant” means “payer” in French).
You as the policyholder receive a copy of the bill. If an expense is not covered by your insurance policy, you will have to pay for it yourself. Even when a healthcare bill is covered, you will still have to cover the deductible and the out-of-pocket payment.
Direct claim settlement system: Pros
- You don’t have to fuss with receiving bills, paying them and then forwarding them to your health insurance provider for reimbursement. That means less hassles for you.
- In the tiers payant system, your health insurance provider is responsible for making sure bills are paid on time and in full. That makes it a much more hassle-free option than the “tiers garant” system, in which budget health insurers often delay reimbursement of medical expenses for up to 3 months. That can make paying medical bills on time difficult or put you in a financial bind. This is especially true if you don’t have a lot of savings or if you are hit with very large medical bills. The tiers payant system relieves you of that risk.
Direct claim settlement: Cons
- You cannot review medical bills ahead of their being sent to your insurer. If an error occurs, you will have to take it up with your insurer rather than your doctor, which can be more of a hassle.
If, for any reason, you prefer that no third parties (particularly your insurer) are informed about a specific medical treatment you are undergoing, the tiers payant system does not give you the option of withholding medical bills from your insurer.