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Basic insurance only fully covers preventive mammograms in cantons with a prevention program.
A woman from the canton of Obwalden feels a lump in her breast. As a precaution, her doctor sends her for a mammogram (x-ray of the breast), even though she suspects that it is not breast cancer.
The woman is irritated that she has to pay for the mammogram in full herself. She said that the health insurance company would have to cover this. Philippe Groux, Vice President of Swiss Cancer Screening, knows who covers the costs of a mammogram and when.
Who pays in cantons with a prevention program? Various cantons have an organized screening program for the early detection of breast cancer. There, the basic insurance covers the entire cost of the mammography except for the deductible of ten percent. That’s around 20 francs. Women between the ages of 50 and 70 can take part in the program, and in some cantons up to 75 years of age. As a rule, they are called up for mammography every two years. Women with symptoms are excluded from the program.
Which cantons have a program for the early detection of breast cancer?
Who pays in cantons without a prevention program? In cantons that do not offer a screening program for the early detection of breast cancer – often for financial reasons – basic insurance does not pay anything towards preventive mammograms. However, it may be that the additional insurance covers the costs. Otherwise, a woman has to pay for a purely preventive mammogram herself.
What applies if breast cancer is suspected? This is a medical act. We are no longer talking about prevention. If a woman has symptoms or complaints about her breasts, the examination will be billed as medical treatment through the health insurance company, with a deductible and deductible.
What does that mean for the case described? It is correct that the woman from Obwalden has to pay for the mammogram herself. This is a suspected case that does not fall under a prevention program. It is billed as a medical examination with a deductible and deductible through the basic insurance. Since the woman’s franchise was not exhausted, she had to pay for everything herself. Even if there had been a preventive examination, the health insurance company would not have paid anything because the canton of Obwalden does not have a screening program.