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:
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