Facts
Caterina A., a member of the Swiss health insurance fund Union, underwent psychiatric treatment with Dr. X., a physician and psychoanalyst, between January and February 1982. The psychotherapy was performed by a psychologist Y., an employee of Dr. X. The health insurance fund refused to cover the costs, on the grounds that Dr. X. was not authorized to bill for delegated psychotherapy sessions to be charged to the health insurance.Considerations
The Federal Insurance Court ruled that delegated psychotherapy to a non-medical psychologist or psychotherapist, employed by the attending physician and acting under his supervision and responsibility, constitutes medical treatment within the meaning of the Health Insurance Act (KVG) and must therefore be covered by health insurance, within the limits set by case law.
However, the tariff agreements between physicians and health insurance funds cannot normatively redefine the legally mandatory benefits for the insured. Art. 23 KVG also does not give the funds the competence to regulate the requirements for economical treatment in a general and abstract manner. The funds can only examine the economic nature of a treatment in a specific case.
Therefore, the clauses of the interpretation agreement that make the coverage of delegated psychotherapy subject to qualification…