Groupe Mutuel denying reimbursements

Complaint is concerning the GM Client nos as stated in "Vertrauliche Informationen".

Some background: we were with GM from Jan'12 to Dec'14 (exception being: my son has continued the dental insurance). In Jan'17 - we joined GM again, the whole family this time.

Since, we rejoined - facing one or the other problems. Initially i had to struggle with the GM to continue my Son's dental insurance. Then there were small incidents like GM decided not to pay for Gynae's costs. Had a call with them and they agreed that the mistake is that their side and corrected it (No. 427474024 of 22 October 2018)

Now, meanwhile we shifted our residence from Adliswil to Wettswil in Sep'17. As a result, we started going to new  family doctor. We consulted our agent and was told that on change of address - GM would ask you for new doctor or since address is changed you are entitled for the doctor change automatically (to be honest - it was one of these as I do not remember clearly).

Recently, I am told that since I did not informed GM about the change of family doctor - I need to get a referral letter from my family doctor on their records (which is from Adliswil) and denied any reimbursements.

My wife, went to same Gynae and now for a relatively small amount to be reimbursed - they are issuing a statement that Dr. Ausra is not registered as a Gynae and I need a referral letter. This way they are issuing a contradicting statement. Here is another invoice which was reimbursed - No. 434422467 of 27 December 2018 and No. 428536453 of 12 November 2018.

Other issues:

I was denied reimbursed the dental costs despite of paying the premiums for dental.

I am told that even in case of accidents, I have to bear 10% of the costs.

In general, communication is getting worse as you don't know who is sitting behind the computer and responding to your issue. Whether the person is capable enough to understand and handle complex issues like this or not.

Writing an email to customer care is not bearing any results - hence, I am writing here:

Last mail I sent to them is on 24th Mar'19 on this matter and this is what I wrote -> 

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--- Here is my response with this regard:
WIth regard to #1 - I got a response from GroupeMutuel saying that ->
@Dr. Ausra - can pl respond here. AFAIK, we have been told that you are a Gynae and we do not need family doctors referral.

And for #2 and #3 - I got this response ->
I get a feeling that Groupe Mutuel is shying away from its responsibility and communication over email is getting very confusing and time-consuming.
Hence, I requested last time to get me the escalation contact. And, as said - not all bills were denied. Hence, I would have never dreamt of sending a separate communication to GM.
But, as said - you are very adamant that you did not do anything wrong and all is my fault. This is not the right way in my eyes and I would ask for some neutral party to intervene and listen to both sides.
Since, this is a mistake on both side - both sides should bear the costs. WHY ONLY ME?

Hence, I would report this matter and the one above to reklamation.ch, to seek a special help here in the matter.
Pl note, till this matter is resolved - I am not paying you for the invoices you denied to pay for. So, pl DO NOT remind me again or send the invoice again with some reminder charges.

Hope I have made my position very clear.

Thanks and regards,
Navin
P.S. - talking over a phone is better than this written communication which can be interpreted in some different manner. And, I am not showing any disrespect or disregard to what you said. Simply, that it is not the fact.

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Hoping to have a positive response,

Navin Sharma

P.S. attached some responses from GM

• Explications