When you pay for private or semi-private Supplementary Hospital Insurance, you are covering the costs of a free choice of doctor, additional comforts and accommodation benefits. In concrete terms, the latter translates to a one or two-bed room plus additional care services. We regularly renegotiate the tariffs associated with these benefits with the hospitals. During this process, we advocate fair prices and transparent pricing models, with a view to ensuring that your premiums remain affordable.
Tariff negotiations can temporarily end in an impasse. If no agreement can be reached with the relevant hospital, this results in a so-called unregulated situation for the semi-private or private ward. Depending on the Supplementary Hospital Insurance, this means that as a customer you have to pay some or all of the costs yourself.
If Helsana cannot come to an agreement with a particular hospital, maximum tariffs may be temporarily imposed. This means that we only pay the maximum amounts set by us, so you may incur uncovered costs. In order to ensure that maximum tariffs do not apply at your preferred hospital, please examine the following list:
If a hospital has not signed a contract with us, we will not assume any costs for an inpatient stay from Supplementary Hospital Insurance. In order to ensure that no uncovered costs arise, we will be happy to advise you and point out the possibility of being treated at other hospitals nearby. In order to ensure that no unregulated situation exists where your preferred hospital is concerned, please examine the following list:
The hospitals included on the following list are Helsana KVG contract hospitals, and the associated range of benefits is also specified. Cost coverage exists for them arising from the above-mentioned Supplementary Hospital Insurance products subject to the valid Insurance Conditions and without any statement to the contrary:
It is important to Helsana to stabilise and maintain benefit costs and thus also premiums. In order to ensure that this is the case, Helsana consistently negotiates with hospitals. That is why Helsana has decided that it will only conclude contracts with hospitals which do not generate above-average costs where Helsana patients are concerned. Helsana strives to conclude contracts for semi-private and private wards with all hospitals which work well and efficiently. An unregulated situation only arises in exceptional circumstances, specifically if multilevel negotiations fail.
If an insured person gets into a situation where they have to finance some or all of the costs in spite of their Supplementary Hospital Insurance, it is understandable that it can be perceived like this. However, in order to avoid tariffs which in our opinion are exorbitant and soaring costs, Helsana must be a tough negotiating partner. Unregulated situations are an important bargaining chip in these negotiations.
It varies. An unregulated situation is undesirable for both the insurance company and the hospital. The insurance company annoys customers affected and the hospital loses important income. Both sides therefore try to find a solution as quickly as possible. However, as the positions of the opposing parties often become entrenched, experience has shown that such a situation can persist for between two and six months, and even longer in rare cases.
If an undertaking has already been given to pay the costs for your medical procedure, you are not affected by this. If you are uncertain or no undertaking to pay costs has been given, it is particularly important to us that you contact us. We will gladly advise you at any time and do everything in our power to ensure that we can offer you a first-class service. Together we will find an equivalent hospital near you in which the costs are covered pursuant to your Supplementary Hospital Insurance.
Depending on a hospital’s size and importance, the persons insured with Helsana are proactively informed of any unregulated situation and when it comes to an end.
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