Facts
O. was compulsorily insured with the insurer Assura for medical and hospital care from January 1, 2001 until her death on October 10, 2002. During this period, she resided in a medical-social institution P. in the canton of Bern, classified at care level 4. The institution invoiced Assura daily care costs of CHF 68 in 2001 and CHF 70 in 2002. O. also invoiced these costs to the institution, deducting the benefits from the insurer. After O.'s death, her heirs contested this invoicing, arguing that it was contrary to the Health Insurance Act (HIA). They requested Assura to represent them in this dispute against the medical-social institution before the cantonal arbitration tribunal, in accordance with Art. 89 HIA. Assura refused this request.Considerations
The Federal Tribunal considers that the conditions of Art. 89 para. 1 HIA, which provides for the competence of the arbitration tribunal for disputes between insurers and service providers, are not met in this case. Indeed, the two contracting parties have fulfilled their obligations within the framework of the third-party payer system, and their disagreement on the legal interpretation is not sufficient to constitute a dispute within the meaning of this provision. Therefore, there is also no room for representation of the insured by the…