Health care costs in Germany reimbursed after all

(this article was published in Dagblad de Limburger of 23-2-2022)

By Benti Banach

A Maastricht woman living in Belgium will still get a refund of all her health care costs for her treatment in Germany. Her appeal is well-founded, says the Central Appeals Tribunal.

MAASTRICHT – The woman, who wishes to remain anonymous, paid more than 16,000 euros for surgery and follow-up treatment for her breast cancer in a German hospital. The CAK refused to reimburse these costs because she lives in Belgium and receives a pension from the Netherlands. According to the CAK, she could only be reimbursed for a planable operation in Belgium and the Netherlands and acute, non-planable care in a third country.

After an examination at the MUMC+ in Maastricht, which diagnosed grade 2 breast cancer, she went for a second opinion to a hospital in Osnabrück. A week later, she underwent surgery there. This operation could also have taken place in the Netherlands or Belgium, the CAK reasoned, because it was planned and not acute care. So no reimbursement. The court ruled in favour of CAK, in appeal the Central Council of Appeal also ruled that in order to receive reimbursement for care in a third EU Member State with at least one night of hospitalisation, permission from CAK is required, which she did not have. However, the Central Council of Appeal did not know whether she was entitled to reimbursement for the follow-up treatment (9,000 euros) and referred the matter to the European Court of Justice in Luxembourg. The court ruled in October 2021 that the woman must be considered an insured person according to the European Patient Directive and therefore entitled to this reimbursement.

On top of this, the court also saw that the Netherlands, when drafting the Patient Directive, did not include anything about asking permission for a medical procedure abroad, while that possibility was there. “Under this legal consideration, the CAK cannot impose the requirement on my client that she should have asked permission for the intramural costs,” said Maastricht lawyer Jacques Gerits, who represented the woman up to the court. He called the court’s decision a groundbreaking ruling that has consequences for residents of the Euregion. 

The CAK, too, now concludes that the Maastricht woman living in Riemst must be reimbursed for the cost of the operation itself (7,000 euros).