Andorran Court Denies Reimbursement for Hyperthermia Cancer Treatment
Superior Court dismisses oncology patient's appeal against CASS, ruling hyperthermia not covered by regulations despite efficacy evidence.
Key Points
- Court dismissed appeal for 2,989.02-euro hyperthermia not in CASS regulations.
- Rejected equivalence argument; no comparable covered treatment per forensic report.
- CASS approved only CT scan and radiotherapy; hyperthermia out-of-pocket.
- Ruling: Courts must apply regulations strictly, no adjustments for efficacy studies.
The Andorran Superior Court's administrative chamber has dismissed an appeal by an oncology patient seeking full reimbursement from the Caixa Andorrana de la Seguretat Social (CASS) for a hyperthermia treatment costing 2,989.02 euros.
The court ruled that hyperthermia is not listed in the CASS regulations on covered medical procedures. It also rejected arguments for coverage by equivalence, citing a forensic report that found no existing covered treatment with comparable therapeutic relevance to oncological hyperthermia.
The patient had undergone radiotherapy, initially requested at Barcelona's Teknon clinic—a facility not contracted by CASS for that therapy—following a referral from Andorra's Nostra Senyora de Meritxell Hospital Oncology Unit. The CASS approved vouchers only for a simulation CT scan and a radiotherapy package, explicitly instructing the hospital to inform the patient that the hyperthermia session fell outside its nomenclature and required out-of-pocket payment, with receipts submitted for review.
CASS emphasized during proceedings that a prescribing doctor's status as a contracted professional does not automatically qualify a treatment for coverage, nor does it waive requirements for prior nomenclature inclusion or administrative approval. The agency also clarified that hyperthermia's need to precede radiotherapy within two hours constitutes a technical scheduling condition, not a legal medical emergency.
The court acknowledged scientific studies cited by a forensic expert, which suggested hyperthermia enhances cancer treatment efficacy by 20%, and her recommendation to apply chemotherapy or radiotherapy reimbursement coefficients. However, it stressed that neither the administration nor the courts can adjust normatively fixed percentages, and must apply the relevant regulations strictly.
The ruling underscores that CASS reimburses only listed services at specified rates, leaving non-covered treatments to patients' personal expense.
Original Sources
This article was aggregated from the following Catalan-language sources: