Bill too high? How to check and dispute a doctor’s bill and a statement of benefits

Which bill is too high?

Around a single treatment you receive up to three documents. Who is responsible for correcting an error depends on which of them is wrong.

The doctor’s bill and the copy of the invoice list the services. Errors there are errors by the practice: a consultation that never took place, a duplicate item, a wrong tariff. The statement of benefits is the health insurer’s bill to you, or its credit note. Errors there are calculation errors by the health insurer, for example with the deductible or with the annual maximum retention fee.

Under tiers payant, you often only notice an error by the practice when the health insurer bills you for the deductible and retention fee. That is why it pays to read the copy of the invoice as soon as it arrives. As long as you have not used up your deductible, you pay every franc that was overcharged yourself.

Step by step: checking and disputing a bill

1. Get the bill or the copy. If the copy is missing, ask the practice or your health insurer for it. On request, you receive it free of charge on paper (Art. 42 para. 3ter KVG).
2. Compare the items with what you remember. Do the treatment dates match your calendar? Did you receive every service listed? How long did the consultation last? Note any discrepancies straight away.
3. Ask the practice. Call or write and ask for an explanation. Many errors are data entry errors and are quickly corrected. Ask for a corrected bill in writing.
4. Under tiers garant, pay only the undisputed part. Tell the practice in writing which items you are disputing. Submit the bill to your health insurer anyway and note your objection.
5. Inform your health insurer. Forward your complaint to the health insurer, with the invoice number and the items concerned. The health insurer checks tariff and cost-effectiveness and can refuse to pay or claim the money back (Art. 56 para. 2 KVG).
6. Check the statement of benefits. After the correction, the health insurer must recalculate your co-payment. Check that the credit appears on your next statement.
7. Involve the ombudsperson. If you get nowhere with the practice and the health insurer, the Office of the health insurance ombudsperson mediates free of charge.

How to recalculate tariff items, tax points and outpatient flat rates in detail since 2026 is shown in the article Checking a TARDOC bill.

Your rights: what a bill must contain

Detailed and understandable: The service provider must send the debtor a detailed and understandable bill and give them all the information needed to check the calculation of the remuneration and its cost-effectiveness (Art. 42 para. 3 KVG). Under Art. 59 para. 1 KVV, this includes in particular the calendar of treatments, the services at the level of detail of the tariff, the diagnoses and procedures needed for the tariff, the number of the health insurance card and the AHV number (the 13-digit number of the Old-Age and Survivors’ Insurance).

Separate for each type of insurance: The practice must issue two separate bills, one for benefits of basic health insurance and one for other services (Art. 59 para. 2 KVV). If a medical certificate for your employer or a service covered by supplementary insurance appears on the same bill as basic health insurance, you may ask for it to be split.

Tariff protection: Service providers must keep to the agreed tariffs and prices and may not charge any further remuneration for benefits of basic health insurance (Art. 44 para. 1 KVG). Surcharges for “comfort” or “administration” on a compulsory benefit are therefore not allowed, unless the tariff provides for them.

Cost-effectiveness: The practice must limit its services to what is in your interest and necessary for the purpose of the treatment; anything beyond that does not have to be paid by the health insurer (Art. 56 para. 1 and 2 KVG).

Passing on discounts: If the practice receives discounts from suppliers, for example on medicines or aids and appliances, it must in principle pass them on to the debtor; under tiers garant, that is you (Art. 56 para. 3 and 4 KVG).

Reimbursement: Who may claim back an overpayment depends on the system. Under tiers garant, it is you or your health insurer; under tiers payant, it is the health insurer (Art. 56 para. 2 KVG). Disputes between health insurers and service providers are decided by a cantonal arbitration tribunal; under tiers garant, your health insurer represents you there at its own expense (Art. 89 para. 1 and 3 KVG).

Recalculating the statement of benefits

Health insurers can make mistakes too. The statutory values you can use to check any statement of benefits:

Typical errors on a statement of benefits are a deductible charged in January for the new year although the treatment took place in December; a retention fee above the annual maximum; a hospital contribution for a child; or a co-payment on services during pregnancy. Which deductible is cheaper for your annual costs is shown by the deductible calculator.

Sample calculation: two errors, two routes

Example with fictitious people. The amounts are assumed; the deductible and retention fee follow the law.

Error by the practice. Rahel, 34, has a deductible of CHF 2,500 and no costs so far up to May 2026. Her practice bills under tiers payant. On the copy of the invoice for CHF 412.40, she finds an X-ray that was never taken and a second consultation on a day when she was not at the practice.

Error by the health insurer. Peter, 67, has a deductible of CHF 300. By October 2026, the health insurer has already charged him CHF 680 in retention fees. In November, a bill for CHF 600 arrives. The correct amount would be another CHF 20 in retention fee, because after that the annual maximum of CHF 700 is reached. The statement of benefits, however, asks for CHF 60, which is 10 % of the whole bill. Peter reports the error in writing, and the health insurer corrects the statement to CHF 20.

Special cases

Hospital bill after an inpatient stay

For inpatient treatment, the health insurer owes its share directly to the hospital (Art. 42 para. 2 KVG), and the hospital shows the shares of the canton and the health insurer separately (Art. 42 para. 3 KVG). You receive a copy and later the statement of benefits with the deductible, retention fee and hospital contribution. Above all, check the number of days in hospital: no hospital contribution is due for the day of discharge (Art. 104 para. 1bis KVV). From 01.01.2028, the financing between cantons and health insurers changes; what this means for bills and premiums is explained in the article EFAS 2028. Your deductible and your retention fee stay the same.

Private or semi-private ward and additional services

The tariff protection of the KVG does not apply to benefits of supplementary insurance. What the health insurer covers is determined by your contract and the general terms and conditions; what counts are the general terms and conditions and the information from your health insurer. For planned procedures, ask beforehand for a written cost approval and a cost estimate, so that you are not faced with a difference that no insurance covers.

Dentist

Dental treatment is covered by basic health insurance only in a few cases defined by law, for example for severe, unavoidable diseases of the masticatory system or for accident damage that the health insurer pays for (Art. 31 KVG). Usually you pay the dentist’s bill yourself or through dental insurance. The tariff protection of the KVG does not help you then. Ask for a written cost estimate before any larger treatment.

Reminder and debt enforcement

If you dispute a bill under tiers garant, stay in written contact with the practice and pay the undisputed part. If you nevertheless receive a payment order, you can file an objection (Rechtsvorschlag) with the debt enforcement office within 10 days of receiving it. If you only dispute part of it, you must state the disputed amount exactly; otherwise the whole claim is considered disputed (Art. 74 para. 1 and 2 DEBA).

The health insurer rejects the whole bill

Then the question is no longer the amount but whether the benefit is covered at all. You can ask for a written decision and file an objection within 30 days (Art. 49 and 52 ATSG). The whole procedure is shown in the article Benefit rejected.

Common mistakes

• Filing the copy of the invoice without reading it. Under tiers payant, it is your only means of checking. Otherwise errors end up unnoticed in your deductible.
• Not paying the bill at all. Under tiers garant, you risk reminder fees and debt enforcement. Pay the undisputed part and dispute the rest in writing.
• Informing only the practice. The health insurer pays or reimburses. It must know that you are disputing an item, and it can claim money back itself.
• Forgetting the annual maximum retention fee. Above CHF 700 a year (children CHF 350), the health insurer may not charge any more retention fee.
• Checking the bill date instead of the treatment date. For the deductible, the date of treatment is what counts. A treatment in December belongs to the old year.

You will find all the basics on billing in the section Understanding basic insurance. How reimbursement works under tiers garant is explained in the article Reimbursement claim form. Contact details for billing questions are listed in the health insurer profiles, and in the premium calculator you can compare the premium and deductible of all health insurers in your municipality.