We conclude from this that, before issuing such reports, the healthcare provider must inform the insured that a corresponding request has been received from the health insurer. He must then inform the insured of the possibility of transmitting these reports via the medical examiner. Only if the insured person does not make use of this option may the service provider send the reports to the administration of the insurance company. Otherwise, he risks criminal proceedings for violation of medical secrecy. Since such a procedure may be administratively complex and time-consuming, and since the service provider will not be compensated for his services as long as this is the case, he has the right to choose the path via the medical examiner even without the instruction of the insured person.
Source: FDPIC – Release of nursing reports to health insurers