The statutory health insurance companies may also have to pay very high costs for treatment abroad. This was decided by the Social Court of Bremen in favor of a life-threatening ill adolescent in a judgment involving a treatment of 300,000 euros in the USA. Promising treatment options in Germany no longer existed.
The adolescent was born with a severe heart defect and as a result suffered from a rare disease, fibroblast bronchitis. This is associated with life-threatening asphyxia by constantly re-forming protein lumps. According to studies, half of all sufferers die within five years - or those affected need a heart transplant within this time.
In 2016, a medical doctor from Philadelphia in the US presented a new treatment method in a medical journal. The occlusion of certain lymphatic glands could prevent the formation of protein clots. He was able to cure 18 patients.
When the teenager's parents learned about it, they asked for the cost of treatment in the United States. Several German clinics and doctors of the boy supported this, as well as the medical service of health insurance. All other options are exhausted and the new method therefore the only chance.
Already a first complaint in the express procedure was successful
Nevertheless, the health insurance company did not want to pay the costs. The method was not recognized. In addition, give the US clinic no reason for the high cost of about 300,000 euros.
With his complaint, the boy had 2017 already in an express procedure success. He was then treated in the United States and has reportedly no more choking attacks. Now the Social Court was right for the adolescent even in the main proceedings. Thereafter, the health insurance has to carry the initially only extended costs finally.
As a reason, the Bremen judges declared that the law of the statutory health insurance know "no limitation of treatment claim because of high costs." Also that the treatment took place in the USA, does not preclude a cost assumption. After all, promising treatment in Germany was no longer possible, according to all doctors involved in the procedure.
The health insurance does not recognize the judgment
Already in 2005, the Federal Constitutional Court ruled that the statutory health insurance companies have to pay for non-life-threatening illnesses also unrecognized healing methods, if they promise "a not altogether distant prospect" for healing or alleviation.
Nevertheless, in the case of Bremen, the health insurance company does not want to recognize the verdict of the Social Court. She has already appealed to the Landessozialgericht Niedersachsen-Bremen.