Facts
B., born in 1960, suffered from severe chronic acne since her youth until around the age of 25, which left disfiguring facial scars. In the spring of 1998, B. and her physician Dr. med. R. applied for cost coverage for a laser therapy (skin resurfacing) at Clinic X in order to at least partially treat the scars. The Assura Health and Accident Insurance rejected the request for benefits, whereupon B. filed a complaint.
The Administrative Court of the Canton of Lucerne dismissed the complaint. B. then filed an administrative court appeal to the Federal Insurance Court.
Considerations
The Federal Insurance Court states that laser therapy for the treatment of acne scars is generally to be considered a mandatory service of the compulsory health insurance. The legal presumption is that medical treatments meet the criteria of effectiveness, appropriateness and cost-effectiveness, as long as they have not been expressly declared non-reimbursable by the Federal Council or the Department.
Although laser therapy for the treatment of acne scars was included in Annex 1 of the Health…