By Le Figaro with AFP
Published update
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The Paris Court of Appeal dismissed on Friday a young woman with a two-hand transplant in the United States in 2016, who demanded reimbursement of more than a million dollars from social security, according to a decision of which AFP was aware.
«Coverage of care provided abroad is only a simple option for social organizations, exceptionally and after a favorable opinion from the medical control.“, decides the court in its judgment, reversing a previous court decision.
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Septic shock
The plaintiff, Laura Nataf, had four limbs amputated in 2007 at the age of 19 after septic shock. In 2013, she was placed on the list of patients awaiting a transplant, in a research program at the Georges-Pompidou hospital in Paris (AP-HP). But the health authorities had not renewed the authorization for this program, then the young woman had been placed in “temporary contraindicationin early 2016. She then decided to have surgery in the United States at the suggestion of her surgeon Laurent Lantieri, known as one of the pioneers of face transplants.
In February 2016, Health Insurance had sent a refusal of coverage, but the young woman had nevertheless had surgery at Penn Medicine Hospital in Philadelphia, which then sent her a bill for $ 1.13 million.
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At first instance in July 2021, the Paris court had canceled the refusal to cover health insurance and ordered it to pay two-thirds of the amount claimed. But the latter had appealed. “Without misunderstanding that at the time there was no other service that could accommodate her and that she turned to a foreign team to be able to benefit from the double transplant (…), it should be noted note that the Social Security court could not replace the assessment of the fund, itself bound by the unfavorable opinion of the medical control, to decide on the reimbursement of the care provided abroad“, argues the Court of Appeal.
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