I am pointing out a legal situation that has received legal clearance in practice. Yet the health insurance fund refuses to take account of case law and does not reimburse insured persons for the costs they incur for medical services provided by providers who are not in a contractual relationship with the health insurance fund.
The rule is that insured persons receive these services free of charge, provided they present themselves on the basis of a referral note issued by a family doctor or specialist doctor. Insofar as health care providers who are in a contractual relationship with the health insurance fund are unable to provide the necessary medical services to the insured person within a period of time which meets the requirement of the urgency of the insured person's medical condition, the health insurance fund is obliged to reimburse the costs incurred by the insured person for the medical services he has received in a private hospital.
The interpretation relied on by the health insurance company to the effect that the insured person could not benefit from the services included in the basic package, on the basis of a medical prescription, from providers who do not have a contract with the health insurance company, is such as to run counter to the constant case-law of the ECHR as regards the positive obligations of States to guarantee the right to life and to the mental and physical integrity of citizens.