Facts
[B.], residing in the canton of St. Gallen, was legally insured for healthcare by Visana. From December 15, 2003 to February 28, 2004, she underwent inpatient neuro-rehabilitation treatment at the Rheinburg-Klinik Walzenhausen in the canton of Appenzell Ausserrhoden following a stroke with hemiplegia. Visana issued a cost approval of CHF 220.- per day to the clinic, but the clinic invoiced [B.] at a daily rate of CHF 580.-. The cantonal court obliged Visana to reimburse the insured person the daily flat rate of the Valens Clinic of CHF 499.- (or CHF 541.- from January 1, 2004) for the inpatient stay at the Rheinburg-Klinik. Visana filed an administrative court appeal against this decision.Considerations
The Federal Court states that the hospitalization of the opposing party did not occur for medical reasons outside the canton of residence, as the required service is offered in the canton of St. Gallen. Since there were no medical reasons within the meaning of Art. 41 para. 2 lit. b KVG for the stay at the out-of-canton Rheinburg-Klinik, the appellant must cover the costs at most according to the tariff applicable in the canton of residence (Art. 41 para. 1 sentence 3 KVG).
The Federal Court considers it inadmissible to guarantee the insured person reimbursement of costs to the extent of the highest tariff of an intra-cantonal hospital suitable for the treatment of their illness in every case. This would result in insured persons in cantons with high tariffs being able to extend their right of choice to many or all out-of-canton hospitals without cost risk, although…