Insurance battle: Woman fights over costs for vital surgery!

Insurance battle: Woman fights over costs for vital surgery!

An Upper Austrian woman recently experienced a shocking incident when she went to a hospital emergency room due to severe abdominal pain. After an initial examination, the doctors were alerted to a gynecology department, where a fluid accumulation in the abdominal cavity was finally discovered. The patient subsequently had to undergo surgery that same evening because she was diagnosed with an unknown ectopic pregnancy. The cost of the operation was around 4,000 euros. However, the woman's private health insurance refused to cover the costs because the tariff did not cover medical treatments in connection with pregnancy. This decision caused significant stress and uncertainty for those affected.

The patients then turned to the Upper Austrian Chamber of Labor. This argued that the procedure had to be covered due to an acute life-threatening condition. After a second intervention, the insurance company gave in and finally covered the costs. In the future, the Chamber of Labor recommends that you check with your private health insurance company whether there is appropriate coverage before being accepted into the special class in order to avoid similar situations.

The role of private health insurance

The case of the Upper Austrian woman sheds light on the importance of private health insurance, especially for pregnant women and those starting a family. In Austria, private health insurance is becoming relevant for many because it offers additional services that are often not covered by statutory health insurance. During pregnancy, five free medical examinations are available through the mother-child pass, but many additional pregnancy examinations are not covered by health insurance and must be paid for privately.

Prenatal diagnostic examinations and alternative medical treatments are also often not included in the statutory health insurance provider's catalog of services. In addition, elective doctors must initially be paid privately, although the cost per unit can be between €150 and €200. However, from July 1, 2024, elective doctor invoices can be submitted directly to the statutory health insurance company, which will reimburse part of the costs. Which costs are then covered by private health insurance depends on the respective tariff.

Additional information about pregnancy benefits

With regard to midwifery services, it should be noted that a one-hour consultation between the 18th and 22nd week of pregnancy is free, while other services are mostly private services. Here too, health insurance contracts often only cover part of the offerings, and elective midwives usually cost 80% of the usual health insurance tariff. It is also interesting that there are special waiting periods of 7 to 9 months for pregnancy and childbirth in private health insurance, which is why such insurance should ideally be taken out during family planning.

Some private health insurance companies offer immediate insurance cover without waiting time for existing pregnancies, which can be of great benefit to many couples. Independent insurance brokers like PRIVATpatient.at can provide helpful support in finding suitable tariffs.