Facts
L., born in 1963 and insured with Helsana, was diagnosed with breast cancer in 2005. Having been proposed a radical mastectomy in Switzerland, possibly associated with immediate breast reconstruction, L. turned to the Y. Institute in Italy to undergo a quadrantectomy with localized intraoperative radiotherapy, an intervention not available in Switzerland but which would have allowed breast conservation. Helsana rejected the request to cover the costs of this treatment abroad, considering that adequate care could be provided in Switzerland.
The Insurance Tribunal of the Canton of Ticino dismissed the insured's appeal, considering that the alternative mastectomy intervention, considered as the standard treatment, could have been performed in Switzerland without significant and considerably higher risks compared to the intervention in Italy.
L. appealed to the Federal Tribunal, requesting reimbursement of the expenses for the treatment carried out in Italy.
Considerations
The Federal Tribunal dismissed the appeal, confirming the decision of the cantonal judges.
According to case law, an exception to the principle of territoriality is possible only if there is no possibility of treatment in Switzerland or if it is established, in a particular case, that a therapeutic measure in Switzerland involves significant and considerably higher risks for the patient compared to an alternative treatment abroad. In the present case, the cantonal judges found, based on a detailed expert…