Frances Swaine and Merry Varney of Leigh Day & Co are currently instructed by a client who is seeking to reclaim the cost of seeking healthcare treatment in Europe (countries belonging to the European Economic Area only, the “EEA”).
Do you have a right to reimbursement?
Up until very recently, the NHS’s position on this issue was thought to be unclear. However, we consider that there has long been a right to reimbursement for the costs of treatment in the EEA, which stems from Article 49 of the EC Treaty. It is our view that where there would be an undue delay if treatment were obtained through the NHS, patients who decide to seek treatment elsewhere in Europe are entitled to a reimbursement.
Recently the Department of Health have issued further information and guidance on this issue and it is now possible to either:
(a) Use the E112 form to seek prior authorisation for treatment overseas; or
(b) Seek reimbursement under Article 49 on your return if you can show that you faced undue delay (although no accessible system is in place).
Leigh Day & Co are currently arguing in Mr I’s case that there is an obligation to establish an adequate and accessible system of reimbursement for patients relying on their Article 49 rights.
Mr I
Mr I suffers from a serious heart condition and in May 2005 he was informed that he needed coronary bypass surgery. Mr I was told by his GP that he ought to have the operation within 2 to 3 weeks. Despite this comment, Mr I’s case was classified as ‘routine’ and he was told the next available appointment for a consultation with a Consultant was in October 2005.
Mr I was understandably very concerned about the delay in having his operation, and he feared that this delay might be of serious consequence to him, even fatal. Mr I therefore asked whether or not the consultation stage could be forgone on the basis that it was already clear that Mr I required the operation. This request was refused, and therefore Mr I faced the prospect of waiting some 5 months before a consultation, and an unknown priod thereafter for the operation. Mr I therefore decided to research the costs of undergoing the operation privately, and he became aware that it was significantly cheaper to do so in Germany.
Before flying to Germany, Mr I did try and seek confirmation from his local health authority that they would reimburse the costs of the operation in Germany. The local authority turned down his request and verbally responded saying that Mr I was not eligible to reclaim the costs as such reimbursement was only available if the NHS was unable to offer treatment within a six month period from the time of any consultation.
Due to Mr I’s grave concerns about delaying with the operation, he went ahead and flew to Germany in July 2005 and underwent the required coronary bypass surgery.
Mr I is now seeking reimbursement for the cost of his operation.
Frances Swaine and Merry Varney are keen to hear from individuals who have similar stories to Mr I, and have sought treatment elsewhere in the EEA and been unable to claim reimbursement. Depending on the facts and circumstances of your case, we may be able to assist you with reclaiming the monies you have spent.
