Health insurer told to pay for girl’s treatment not covered by policy

DutchNews.nl, December 19, 2014

Health insurance companies can be forced to pay the bill for treatment not covered in the basic health insurance package in extreme cases, the Dutch Supreme Court said on Friday.

The Supreme Court was looking into the case of an 11-year-old girl with an extremely rare and debilitating illness who could only be treated by drugs aimed at adults. Her insurance company refused to pay for the drugs because they were not covered in the statutory health insurance package.

The Supreme Court said in its ruling that such treatment should fall under the ‘essential care’ clause in the basic health insurance package and ordered the insurance company to pay up. The medicine is the only treatment available for the girl.

In addition, the court said the medicine is not covered for use in children because there has not been enough research done on its effect on youngsters.

The case comes at a time when the government is attempting to give more powers to health insurance companies to determine where certain categories of patients can be treated.