Paper war: For two years, Claudio Götti (39) fought to be removed from the black list of his health insurance company.
Tobias OchsenbeinEditor Politics
Actually, Claudio Götti (40) from Flawil SG would have wanted to start a new life after his private bankruptcy. “I used to make mistakes, I got 130,000 francs in debt. But I stood by it, looked for ways to start over and went for it.” But someone put obstacles in his way, he says: his health insurance company Visana.
Götti also had debts to Visana and was therefore on the black list of defaulting premium payers at the social insurance institution (SVA) of the canton of St. Gallen. This means that the health insurance would only have paid for medical services in emergencies. With the conclusion of the private bankruptcy, which the Wil SG bankruptcy office completed in March 2020, Götti was removed from the black list again. Nevertheless, Visana did not reimburse him in full for the mandatory services afterwards, says Götti.
Benefits only resume after the debt has been paid off
He noticed this two months after bankruptcy when his teeth hurt. The subsequent necessary root treatment threatened to bring the eastern Swiss into financial difficulties again. Because Visana did not want to pay for doctor, diagnosis and laboratory costs.
Götti says: “Visana insisted that I first pay off my debts before I could claim benefits again. But: The debts are bankruptcy assets, that’s not okay. This behavior took away all my chances from the start to get back on my feet.” Since the time of his private bankruptcy, he has always paid his health insurance premiums on time, he explains, over 400 francs a month for two years.
Götti insisted over and over again, as he says. Sent registered documents, made phone calls, sought on-site conversations. In vain – although the SVA St. Gallen already confirmed in August 2020 that they had deleted him from the black list and informed his insurance company.
The insurance says on request: “The allegations against Visana do not apply. Visana itself never kept such a list. The Canton of St. Gallen had asked us to only reimburse Mr. Götti for emergency treatment. Visana was legally obliged to comply with this instruction.» Emergency treatments were possible at any time and Götti would have been reimbursed.
Because Claudio Götti did not feel fit for a long time, he went to the doctor in January 2022 and wanted to be examined. The latter refused an investigation because of Visana’s payment freeze.
In February, the pain became unbearable, and Götti had to go to the hospital as an emergency. An operation followed. Eventually he was diagnosed with Crohn’s disease, a chronic intestinal disease that he will probably have to live with for the rest of his life. A shock for Götti. He says: “I don’t blame Visana for the illness, but it shouldn’t have happened if the health insurance company had fulfilled its obligations. Visana negligently endangered my state of health.”
Götti got to the ombudsman’s office. This insisted several times at the health insurance. It was not until March 2022 that Visana announced that the “reimbursement receipts were mistakenly rejected by our benefit center” and paid the costs retrospectively.
Claudio Götti is considering taking legal action. He is currently looking for legal support and collecting money. “It’s the last hope I have of finally being able to sort everything out.”
The black list on which defaulting premium payers ended up was abolished in the canton of St. Gallen at the beginning of December 2021.