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V 2023 2 • VG SZ V 2023 2 KI-generiert

Midwifery Service Coverage Dispute

Geschäftsnummer V 2023 2
Gericht / Behörde
Rechtsordnung Schweiz · Kanton Schwyz (CH-SZ)
Entscheiddatum
Originalquelle öffnen Entscheidsuche-Spiegel Maschinenlesbares Markdown (.md)

Legislator-Zusammenfassung

KI-generiert

A company providing midwifery services sued an insurer for payment of services rendered to a client, with the dispute centering on whether the services fell under the scope of mandatory health insurance coverage as stipulated in the relevant federal law. The court reasoned that the criteria for inclusion in the mandatory basic health insurance, which require medical necessity and fulfillment of specific legal conditions for coverage, were not met by the specific services billed, particularly as they did not constitute qualified obstetric care as defined in the regulatory framework, leading to the dismissal of the claim against the insurer.

Legislator-Regeste

KI-generiert

Midwifery Service Coverage Dispute: The court reasoned that the criteria for inclusion in the mandatory basic health insurance, which require medical necessity and fulfillment of specific legal conditions for coverage, were not met by the specific services billed, particularly as they did not constitute qualified obstetric care as defined in the regulatory framework, leading to the dismissal of the claim against the insurer.

Schlagwörter

KI-generiert
Deckung der Krankenversicherung medizinische Notwendigkeit erbrachte Dienstleistungen Gesundheitsschutz Versicherungsgesellschaft Krankheit und Mutterschaft
KI-generiert
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Volltext

\n \n \n \n \n

\n\n| | | |\n V 2023 2 |\n |\n \n\n

\n \n \n \n \n

\n\n| | | |\n |\n Entscheid vom 19. Dezember 2024 |\n \n\n

\n \n \n \n \n \n

\n\n| | | |\n Besetzung |\n Dr.iur. Vital Zehnder, Vizepräsident |\n

\n|\n |\n Monica Huber-Landolt, Richterin lic.iur. Achilles Humbel, Präsident Cornelia Kälin, dipl. Hebamme HF, Vertreterin Leistungserbringer Dr.rer.oec. Lukas Brunner, Vertreter Versicherer |\n

\n|\n |\n lic.iur. Prisca Reichlin Brügger, Gerichtsschreiberin |\n \n\n

\n \n \n \n \n \n

\n\n| | | |\n Parteien |\n E.________ GmbH, \n Klägerin, \n vertreten durch Rechtsanwalt lic.iur. F.________, |\n \n|\n |\n gegen |\n \n|\n |\n D.________ AG |\n \n\n

\n \n \n \n \n \n

\n\n| | | |\n Gegenstand |\n Schiedsgericht (Forderung aus Hebammen-Dienstleistungen) |\n \n\n

\n \n

Sachverhalt: