Federal Supreme Court, Decision 9C_584/2019 of 26.02.2020

19. März 2020 – In a recent decision the Federal Supreme Court held that an immune therapy started in the USA for a Swiss patient is to be understood as an accepted treatment abroad, since the patient knew before her departure that she would have to start treatment within the next few weeks because of the cancer diagnosed. Therefore, there is no emergency within the meaning of Article 36 para 2 KVV and the costs for the immune therapy are not to be reimbursed by the defendant. On the other hand, the costs incurred as a result of the diminishing condition of the patient are to be reimbursed, provided that it was predominantly a probable consequence of the diminishing underlying disease; partially approved and rejected to respondent for appropriate clarification.