Unauthorized disease therapy remains the exception

Federal Constitutional Court: No claim for effective emergency medicine
Karlsruhe (jur). The Federal Constitutional Court has emphasized the exceptional nature of a claim of insured persons apart from the benefits catalog of the statutory health insurance. According to a resolution published on Thursday, May 11, 2017, in Karlsruhe (file: 1 BvR 452/17), this presupposes an "individual emergency marked by near-mortality". According to the specific case, such an emergency does not exist if any life-threatening risks can be eliminated by an emergency medication.

The applicant suffers from an autoimmune disease and an inflammatory disease of the skin. As a result, the tongue may swell, creating a choking hazard. To counter this, the woman always carries an emergency kit with her. All attempts to cure the disease have failed.

Picture: goodluz - fotolia

She therefore applied to her health insurance company to cover the costs for treatment with immunoglobulins. These are antibodies derived from donated blood that are channeled through the vein into the bloodstream. The health insurance company declined the reimbursement but from. Immunoglobulins are not approved for their disease.

With her complaint, the woman relied on the so-called Nikolausbeschluss of the Federal Constitutional Court of 6 December 2005 (Az .: 1 BvR 347/98). For life-threatening illnesses then the health insurance companies have to pay alternative or other healing methods outside of their regular service catalog, if they promise "a not quite distant prospect" for healing or relief.

The Federal Social Court (BSG) in Kassel had dismissed the lawsuit - rightly, as the Federal Constitutional Court confirmed.

The Karlsruhe judges affirmed the possibility of exceptions apart from the service catalog of the health insurance companies. At the same time, however, they referred to the broad scope of the legislator in shaping the healthcare system. A claim derived directly from the Constitution is therefore limited to "emergency situations" in which patients "have to resort to all available medical assistance".

Here, however, with the emergency medications "a mortal danger can be met with sufficient certainty." Therefore, it lacks "an emergency-like situation and thus sufficient grounds to override the legislative scope in the design of the benefit right of the statutory health insurance by a directly derived from the Constitution claim," said the Federal Constitutional Court in its decision of 11. April 2017. mwo // fle