26 July 2024 – In its decision of 24 June 2024, the Federal Supreme Court ruled on the appeal by 24 health insurers regarding the reimbursement of fees for urgent care inconvenience flat rates F (Dringlichkeits-Inkonvenienzpauschale 00.2505) under the TARMED tariff system, charged by Permanence A. AG for treatments conducted outside of regular office hours. Permanence A. AG operates an emergency medical practice which can be consulted for urgent medical matters without prior appointment daily (365 days a year) from 7 am to 10 pm.

The Arbitration Court for Health Insurance Disputes of the Canton of Zurich had dismissed the insurers' claim for reimbursement of a total of CHF 1’177’038.62, arguing that Permanence A. AG had incorrectly billed for emergency allowances from 1 July 2016 to 30 April 2021. The Cantonal Arbitration Court found that Permanence A. AG was justified in charging the fees for urgent care inconvenience flat rates F for emergency treatments provided between 7 p.m. and 10 p.m. on weekdays and between 7 a.m. and 7 p.m. on weekends.

The Federal Supreme Court partially overturned the lower court's decision, ruling that Permanence A. AG could not charge emergency inconvenience allowances for treatments performed during publicly advertised hours. The court emphasized that the TARMED tariff system allows for such charges only when treatments occur outside of regular working hours to compensate doctors for the inconvenience. The court ruled that if a medical practice advertises long hours as part of its business model, those hours are considered regular and thus not eligible for inconvenience fees.

The case was referred back to the Cantonal Arbitration Court for a new determination of the repayment amount due from Permanence A. AG.

For more information, see here.