Top court says social security fund must pay private health bills in emergencies

Top court says social security fund must pay private health bills in emergencies

In a landmark court ruling, Greece's top administrative court said that the country's Single Social Security Entity (EFKA) is obliged to cover the entirety of the expenses paid in a private clinic in case of an emergency and when there is no availability in a state-run hospital.

The ruling was issued by the Council of State and concerns any expenses paid in a private clinic that is not affiliated with the National Healthcare System in cases of emergency admissions, when there are no beds in state-run hospitals, or the hospital lacks the necessary diagnosis and treatment methods, or the medical equipment is not functioning.

The case in question dates from 2004, when the spouse of an insured man was admitted to hospital as an emergency in her sixth month of pregnancy. The baby born prematurely had to be admitted to the neonatal intensive care unit for a private maternity hospital for two months. When an incubator was made available in Aghia Sofia state-run hospital, the baby was transferred.

EFKA agreed to pay only 8,599 euros of a total of 24,370 euros in hospital bills incurred by the insured, so the man took the case to court.

The Council of State argued that the social security fund is “obliged to provide its insured with hospital care and when it is objectively unable to do so, it must pay the entirety of the costs incurred by the insured due to this inability, and not only pay the difference.”

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