The statutory health insurance funds have to pay, under certain circumstances, very high costs for treatment abroad. The social court decided the Bremen in favour of a life-threatening ill adolescents in a judgment, which was a 300,000 Euro expensive treatment in the USA. Promising treatment options in Germany it is not.
The youth was born with a serious heart defect and suffered as a result of a rare disease, Bronchitis fibroplastica. This is with bouts of life-threatening Suffocation due to constantly neubild the end of protein clumps. According to studies, half of all Patients die within five years, or the Affected will need within this time, a heart transplant.
in 2016 a physician from Philadelphia in the USA presented in a medical journal a new method of treatment. Due to the closure of certain lymphatic ducts the formation of the protein clumps could be prevented. 18 patients he can heal.
As the parents of the young people found out about it, they claimed the costs for treatment in the United States. Several German clinics and Doctors, the young were in favour of this, as well as the Medical service of the health insurance. All other possibilities had been exhausted, and the new method, therefore, the only Chance.
a first action in the emergency procedure was successful
However, did not want to assume the health insurance costs. The method was not recognized. In addition, the US clinic was no justification for the high cost of around 300,000 euros.
in his complaint, the Boy of 2017 had already fast-tracked success. He was then in the United States to treat and seizures, according to their own information since then, no suffocation. Now, the social court gave the young people in the main procedural law. After that, the insurance company must bear the first, only recoverable costs final.
To justify the Bremen judges declared that the law of the statutory health insurance, know that “no restriction of Treatment due to high costs”. Also, the fact that the treatment was carried out in the United States, a cost is not, contrary to assumption. As a promising treatment in Germany was, according to the assessment of all the processes involved in Doctors.
The insurance company does not recognize the verdict
Already in 2005 decided the Federal constitutional court, that the statutory health insurance funds have to pay in the case of life-threatening diseases not recognized methods of healing, if this “promise of a distant prospect” to healing or relief.
In the Bremen case, the insurance company is not willing to accept the verdict of the social court yet. You put already appeal to the social court of lower Saxony-Bremen.