Facts
The Federal Insurance Court was seized of an appeal against a decision by the health insurer Assura, which had only partially reimbursed the plaintiff's stay costs in a non-subsidized private hospital listed in the cantonal hospital list of the canton of Bern. In the absence of a tariff agreement or a tariff set by the competent authority, the Court considered that insured persons should not bear costs not covered by compulsory health insurance for legal services according to the HIA, with the exception of cost-sharing. It therefore referred the case back to the cantonal instance in order for it to determine a reference tariff in accordance with the law for the reimbursement of services provided by the private hospital.Considerations
The Court first recalled that the tariff protection also applies to private hospitals listed in the cantonal hospital list, so that insured persons cannot be charged costs exceeding the contractual or authority-set tariffs. However, in the absence of a tariff agreement or a tariff set by the authority, it is the responsibility of the cantonal instance to determine a reference tariff in accordance with the legal requirements for the reimbursement of services. The Court…