Facts
The dispute concerns the question of whether and to what extent health insurance must cover medical services provided by a physician to their spouse.
Dr. med. [A.], a practicing physician, was treated by his wife and practice partner, Dr. med. B., for infections, musculoskeletal diseases, and venous conditions, from December 31, 1997 to May 31, 1998. The Visana insurance, with which [A.] is insured for medical care, reimbursed the costs of analyses, X-rays, materials, and medications, but refused to cover the other treatment expenses.
The cantonal administrative court upheld the insurance's decision, finding that the costs of routine medical treatment are part of the family maintenance obligations under Art. 163 CC and therefore do not entitle the treating spouse to a fee.
Considerations
The Federal Insurance Court considers that in a mandatory health insurance system covering these services, the costs of medical treatment by the spouse cannot be claimed under the family maintenance obligation of Art. 163 CC. The fact that the patient can freely choose to be treated by their physician spouse does not preclude the health insurance from covering these costs.
Since the medical…