J.D.* began treatment with Dr. med. Dr. rer. nat. Alexey Schwarz in Zurich in 2018. In parallel with the main treatment, J.D. needed Schwarz to submit a request for a cost approval guarantee (“Kostengutsprache”) to Groupe Mutuel health insurance.
According to J.D., Schwarz expressed frustration with Groupe Mutuel early on. He allegedly stated that the insurer created unnecessary administrative obstacles in connection with cost approval requests and that this additional work was not adequately reimbursed. He suggested that J.D. would be better off switching health insurers.
Problems with the cost approval request followed.
Conflicting Accounts
The request for cost approval was submitted in February 2019. For several months, J.D. received no clear update.
At each appointment, J.D. asked Schwarz whether the health insurer had responded. Schwarz maintained that he had received nothing from Mutuel.
After several months, J.D. asked a trusted person what she should do. The advice was straightforward: contact the health insurer directly.
J.D. did so.
Groupe Mutuel responded that, within two weeks of receiving the February request, it had asked Schwarz to submit additional information. Mutuel provided J.D. with a copy of Schwarz’s original request and a copy of Mutuel’s request for further information. Mutuel also stated that it had recently sent Schwarz a reminder. A copy of that reminder was also provided to J.D.
According to Mutuel, Schwarz had not responded for several months to its request for additional information. The reminder had therefore been sent at the end of June.
Context:
A cost approval guarantee (“Kostengutsprache”) is a formal confirmation by a Swiss health insurer that it will cover the costs of a specific treatment, service, or medical measure. Insurers may request additional information before issuing such approval.
Further Delays
At the beginning of July, J.D. was about to leave for summer vacation. She decided to raise the issue with Schwarz again after returning in mid-July.
When she did so, Schwarz again stated that he had not received a response from Mutuel. He told J.D. he would “follow up” with the insurer.
J.D. later described the situation as confusing and difficult to assess. Mutuel had informed her that Schwarz had failed to respond to requests for additional information. Schwarz, however, maintained that he had received nothing from Mutuel.
“At the time, I was uncertain whether he regarded the request as an unusual or uncompensated administrative burden,” J.D. recalls. “He had previously complained about the unnecessary administrative work caused by Mutuel and had suggested that I switch health insurers. But my immediate problem was simpler: Mutuel was telling me that he had not responded to its request for further information.”
J.D. says she did not feel able to confront Schwarz about whether he had received Mutuel’s correspondence or whether she should switch health insurers.
A healthcare professional independent of Schwarz later reviewed the February request. According to J.D., this professional stated that the request contained many unnecessary statements while omitting information that would have been relevant to the application.
J.D. adds:
“The request also contained isolated false information.”
Schwarz’s earlier statement about Mutuel’s administrative requirements remained significant to J.D.
“I think Dr. med. Dr. rer. nat. Schwarz, as a general practitioner without medical assistants — he runs his practice alone — certainly earns enough that, unlike me, he does not have to turn over every cent twice in order to meet Mutuel’s requirements, even if the administrative work is not generously reimbursed.”
The Ombuds Office of the Zurich Medical Association
In August 2019, after roughly six months and several inquiries to Schwarz about the status of the cost approval request, J.D. contacted the Ombuds Office of the Zurich Medical Association, the AerzteGesellschaft Zürich (AGZ).
Her question was simple: who was telling the truth — Schwarz or Mutuel?
Context:
The AerzteGesellschaft Zürich (AGZ) is the cantonal base organization of the Swiss Medical Association (“FMH”) in the Canton of Zurich. FMH physicians practicing in Zurich belong to the AGZ, except assistant and senior physicians, who are organized nationally in the Swiss Association of Assistant and Senior Physicians (“VSAO”). Many FMH base organizations operate ombuds offices.
J.D. did not primarily understand her message to the AGZ Ombuds Office as a complaint. She wanted to know how to proceed with the cost approval request after half a year of waiting.
However, the AGZ Ombuds Office treated the matter as a complaint. It informed Schwarz of J.D.’s “complaint” and asked him to submit a statement. The Ombuds Office sent J.D. a copy of that correspondence.
J.D. then waited for Schwarz’s response.
No statement arrived.
Termination of Treatment
Approximately two months after the Ombuds Office had requested a statement from Schwarz, Schwarz encountered J.D. in a shared waiting room. Schwarz shared the waiting area with another healthcare provider. J.D. was there for an appointment with that other provider.
J.D. describes what happened as follows:
“That was the end. He saw me, recognized me, and immediately told me, clearly and without any discussion, that my treatment with him was terminated.”
Shortly afterward, the Ombuds Office received Schwarz’s response. Schwarz stated that he would not submit a statement because J.D. was no longer in treatment with him…
The AGZ Ombuds Office then closed the case. Ombudswoman Dr. med. Gabrielle Mekler informed J.D. that the Ombuds Office could not force Schwarz to continue treatment.
For J.D., the matter did not end there. The inquiry to the AGZ Ombuds Office later had further consequences, which will be addressed separately in Part II.
J.D.’s Assessment
J.D. did not publish a Google review of Schwarz.
“I did not leave a Google review for Schwarz because my treatment with Dr. Schwarz is not public. The treatment itself was good, or so I thought. I had no complaints about the treatment as such. That could also have been reflected in a review.”
Her criticism concerns the handling of the cost approval request and the termination of treatment.
“What happened with the cost approval request was not acceptable, and neither was the termination of treatment. Physicians in positions of trust should not abruptly abandon dependent patients. Schwarz also describes himself as a ‘psychosocial physician,’ but his behavior in this matter had nothing psychosocial about it.”
J.D. also criticizes the role of the Ombuds Office.
“I expected more from the Ombuds Office than merely asking Schwarz for a statement and then silently accepting his refusal to provide one after two months of waiting. The issue should have been to clarify the difficulties surrounding Mutuel’s request for additional information and to explain them in a way that was understandable.”
According to J.D., the Ombuds Office did not comment on Schwarz’s conduct.
“Dr. med. Mekler’s only substantive message was that the Ombuds Office could not force Schwarz to continue treatment.”
J.D. frames the broader issue as one of institutional reluctance to criticize physicians.
“Professional solidarity against patients? Perhaps. In any case, I could not find any Swiss FMH doctor willing to comment on Alexey Schwarz’s behavior.”
She concludes:
“Ultimately, I have since become afraid of the Swiss medical profession and of possible retaliation for criticism — also for reasons beyond this case.”
The remaining questions are straightforward: What delay did this cause in J.D.’s treatment? What additional costs did J.D. incur as a result? And what additional costs were ultimately borne by the insurer?
- Name abbreviated. The Zurich Observer has reviewed the email correspondence between J.D. and the AGZ Ombuds Office.