Helsana informs policyholders about the healthcare controlling procedure and the decisions that are reached. Policyholders receive a copy of written decisions with reasons as supplied to the service provider.
Health insurers are authorised by law to require service providers to disclose information. They are not obliged to provide explanations to the insured persons if service providers are asked for additional information in connection with the review of benefits. According to the Data Protection Act (DSG), insurers do not need the patient's approval to release data (article 7a, DSG).
Even though there is no statutory obligation to provide information, policyholders and service providers are informed about the procedure and the decisions in connection with benefit assessments by Helsana's healthcare controlling department.
Policyholders who reside in a nursing home receive additional information:
- Information brochure when admitted to the home;
- Copy of the letter regarding registration with nursing home controlling (during a visit to the home by Helsana healthcare controlling staff);
- Brief welcome for the insured person at the home; if required or requested by the policyholder, a personal discussion with the healthcare controller can be arranged.