Health insurance No cancer treatment abroad

Health insurance companies do not have to pay special diagnostic services abroad

05/07/2012

The statutory health insurance funds do not have to pay the treatment costs for a special diagnostics abroad. A plaintiff had previously had a cancer diagnosis performed by a Dutch doctor and then applied for the costs with his health insurance. The cash register had denied the assumption of the diagnosis costs. The patient then went to court.

Statutory health insurance funds do not have to pay the special costs for examinations abroad, judge the first senate of the state social court Hessen. The funds only have to pay for treatments or examination methods that are also included in the statutory benefits catalog. Although there are exceptions to life-threatening diseases, they are only available if there are no reasonable alternatives available „comply with generally accepted medical standards“, so the judges. Specifically, the judges emphasized a claim to „Top medicine at any price“ do not exist.

In this case, a 74-year-old man from southern Hesse in 2005 had a special MRI diagnosis performed, which is only offered by a Dutch doctor. With the help of so-called USPIO-MRT even small lymph node metastases can be identified by tiny iron particles that escape other diagnostic procedures. The diagnostic costs totaled 1500 euros.

A request for reimbursement of costs was rejected by the fund on the grounds that „special diagnostics is not a contractual service“. The plaintiff emphasized, however, that the investigation was „Surgery that was likely to lead to incontinence and impotence was avoided.“ Nevertheless, the court rejected the lawsuit on the grounds that the health insurance companies do not have to pay anything to maintain or restore their health. Rather, the health insurance based on the prescribed catalog of benefits (file reference: L 1 KR 298/10). A revision was not allowed by the state social court. (Sb)

Picture: Peter Kirchhoff