Facts
In this case, the parties are disputing whether the rate for private patients can be invoiced for a patient's stay in the intensive care unit. The health insurance company KPT/CPT (appellant) disputes that additional services beyond the rate of the mandatory health insurance can be invoiced. The Cantonal Hospital of Fribourg (service provider), on the other hand, argues that a higher rate can be invoiced for treatment in the private ward.
The lower instance had denied the jurisdiction of the arbitration tribunal, as this was not a dispute between the insurer and the service provider within the meaning of Art. 89 para. 1 KVG, but rather the question of whether more had to be paid for a person insured in the private ward due to the supplementary insurance.
Considerations
However, the Federal Supreme Court concludes that in this case there is indeed a dispute between the insurer and the service provider. This is because it is a question of whether the tariff protection pursuant to Art. 44 para. 1 KVG applies and the appellant as the basic insurer is also affected.
The Federal Supreme Court states that the tariff protection also applies to the stay in the private ward, insofar as the costs do not exceed the scope of benefits of…