Dismissal of the appeal against the rejection of the cost approval for dental treatment due to aggressive periodontitis

Facts

The appellant, [A.] , applied to Avenir Krankenversicherung AG for cost approval for dental treatment for "severe aggressive juvenile periodontitis". Avenir Krankenversicherung AG rejected the application, as the requirements for cost approval were not met. The appellant appealed to the High Court of the Canton of Uri, which dismissed the appeal. The appellant then appealed to the Federal Supreme Court.

The appellant requested that the decision of the High Court be set aside and that Avenir Krankenversicherung AG be required to assume the costs of the dental treatment. Avenir Krankenversicherung AG requested that the appeal be dismissed.

Considerations

The Federal Supreme Court applies the law ex officio and is therefore not bound by the arguments raised in the appeal or the considerations of the lower court. The court must examine whether the requirements for cost approval under Art. 31 para. 1 lit. a HIA are met.

The appellant has aggressive periodontitis, but lacks X-rays from their youth, which would be necessary to diagnose juvenile periodontitis. The periodontologist appointed by Avenir Krankenversicherung AG, Dr. med. dent. [B.] , came to the conclusion in his report of 20 February 2013 that "juvenile or prepubertal periodontitis" could not be diagnosed in the 37-year-old patient.

The Federal Supreme Court has…