Organisation: ANS

Created at: 18.05.2026 09:12:59

Question

We have repeatedly received reports from ANS members regarding discrepancies between contracts with health insurance companies (specifically Dôvera) and the scope of medical programs. For the Rehabilitation Program, we have noted the eligibility criteria set by the Dôvera health insurance company, which limits the scope of rehabilitation care provided by providers to direct translations for certain diagnoses: following NCMP (I63.8 and I62.9); following TEP surgeries (16.1, M17.1, and S72.9); for neurosurgical procedures (M16.1,M17.1, and S72.9), spinal surgeries (M51.8; M54.19; M42.99; M48.09), spinal cord surgeries (D32.9; C70.9; D33.9); and following trauma (S06.30; S06.9). These diagnoses do not include all physical therapy patients, nor even all patients within these diagnostic groups.

Answer

Hello, following discussions with the health insurance company and providers, the comment in question pertains to contractual relationships between the health insurance company and the provider, which are not covered by the OSN in this area.