A medical bill is often the most technical document a household receives. Yet it can be checked: the law sets what it must contain, who pays it and what cannot be billed. An insured person who reads it protects their budget, and helps to contain the costs that push premiums up.
Who pays whom: tiers garant and tiers payant
In the tiers garant system, the patient receives the bill, pays it, and is then entitled to be reimbursed by their insurer. Insurers and healthcare providers may also agree that the insurer pays directly: this is the tiers payant system. In hospital, for example, it is the canton and the insurer that pay for the treatment, and the patient receives a statement of their share of the costs.
In both cases, the provider must issue a detailed and comprehensible bill. In the tiers payant system, the provider is required to send the insured person a copy of the bill addressed to the insurer, without the insured person having to ask for it: it is this copy that makes it possible to check what has been billed in their name.
The system used changes how you check. Under tiers garant, the insured person has the bill in hand before paying: that is the best moment to reread it. Under tiers payant, the insurer has already paid; the copy the insured person receives is then used to check after the event, and to report a discrepancy to the insurer, which can claim back from the provider what was wrongly billed.
What a bill must show
The ordinance sets out the content. The bill must in particular show the dates of treatment and the services provided, itemised as the applicable tariff requires. Basic insurance services and other services must be billed on two separate bills. Providers must make sure the bill is comprehensible to the insured person, setting out clearly the type, duration and content of the treatment.
An incomprehensible bill is therefore not something you have to accept: it is a legal obligation that it be readable. The patient can ask the practice or hospital to explain a tariff item, a code or a duration, and asking costs nothing.
The two separate bills have a useful consequence: anything that falls under complementary insurance, for example a supplement for a private room, is not mixed up with basic insurance services. If a single bill seems to lump everything together, it is legitimate to ask for them to be separated.
What changed in 2026: TARDOC
Since 1 January 2026, outpatient medical services have been billed under a new overall tariff system, made up of TARDOC and outpatient flat rates. This system replaces TARMED. Billing for inpatient services, in hospital, has not changed. The tariff items for a consultation may therefore look different from those of previous years.
What cannot be billed
Healthcare providers must keep to the tariffs that have been set, and may not demand higher payment for basic insurance services: this is tariff protection. They must also limit their services to what the interest of the insured person and the purpose of the treatment require; payment for services that go beyond this limit may be refused, and sums wrongly received may have to be paid back.
Checking a bill, step by step
- Check the dates: did the treatment really take place on those days, and not more often?
- Check the services: a consultation billed as longer than it actually lasted, or an examination that did not take place, can be spotted on the itemised bill.
- If in doubt, first ask the practice or hospital for an explanation, since they know the details of their tariff.
- Then report the discrepancy to your insurer, which checks the bill before reimbursing.
Whom to contact in case of disagreement
The insurer checks the bill and reimburses the amount it covers, after deducting the cost-sharing. If the steps taken with the insurer do not succeed within a reasonable time, the Federal Office of Public Health (FOPH) states that the insured person can turn to the health insurance ombudsman. The ombudsman offers neutral, expert and free advice, and can help to clear up misunderstandings and correct errors; it no longer intervenes, however, once a formal decision has been issued or proceedings are under way.
The amount reimbursed can come as a surprise without there being any error. The insurer deducts the cost-sharing: the deductible, as long as it has not been reached for the year, then the 10% co-payment beyond it. A bill of 200 francs received early in the year, with a deductible of 300 francs, is therefore not reimbursed at all, but it counts towards reaching the deductible.
Keeping bills and the insurer's statements for a few years is useful: they make it possible to check the calculation of the deductible and the co-payment from one year to the next, and to find a service quickly if it is disputed later.