French woman transplanted in the United States claims more than one million euros from health insurance

Published on June 22, 2022 at 2:15 p.m.

A French woman transplanted in the United States claims more than one million euros from health insurance – © ROMAIN DOUCELIN / SIPA

Transplanted with both hands in 2016 because she considered this type of operation impossible in France at the time, a young woman is suing the French health insurance system to obtain reimbursement of her bill of more than one million dollars.

At first instance in July 2021, the Paris court canceled the refusal to cover and ordered the health insurance to pay two thirds of the sum. But the latter appealed, and the file will be examined again Thursday before the courts in Paris. The plaintiff, Laura Nataf, had four limbs amputated in 2007 at the age of 19 after septic shock.

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In 2013, she was on the list of patients awaiting a transplant, as part of a research program at the Georges-Pompidou hospital in Paris. But a year later, no compatible donor had been found. The health authorities did not renew the authorization for the program and Laura was removed from the list, her lawyer, Valérie Sellam Benisty, told AFP.

His surgeon, Laurent Lantieri, then offered him to have surgery in the United States and publicized the affair, castigating an “administrative and bureaucratic overload” and deploring the lack of funding “to make these innovations” in France.

In February 2016, the French health insurance system sends a refusal of coverage. But the young woman still had surgery in August at the Penn Medicine Hospital in Philadelphia, which sent her the following year a bill of 1.13 million dollars.

“The medical world is unanimous on the infeasibility of such a transplant in France”

In his letter refusing coverage in the United States, the chief physician of the National Health Insurance Fund (Cnam) “directed Laura Nataf to an experimental program open to the Hospices Civils de Lyon (eastern France) relating to the bilateral allograft of hands and forearms, which would have allowed him to obtain the necessary care in France and the assurance of care, “assured the Cnam to AFP.

“Laura Nataf did not choose to use this option. We consider, as such, that the refusal of support opposed is validly motivated, ”added the public establishment. “It is completely false” to say that “Laura could have been operated on under the same conditions in France”, believes Sellam Benisty on the contrary, recalling his removal from the waiting list.

In 2016, “transplants were suspended in France for lack of funding for research projects, due to the lack of donors and economic constraints”, assures the lawyer. “The medical world is unanimous on the infeasibility of such a transplant in France during the period that occupies this case”.

Sellam Benisty also argues that the refusal of coverage must be sent by registered mail, be signed and be accompanied by a “detailed medical opinion”, which was not the case with the “laconic” letter received by his client .

France was the pioneer of this type of operation, with the first hand transplant performed in 1998 at the Hospices Civils de Lyon by Jean-Michel Dubernard on a New Zealand patient who suffered a cutting accident.

In 2000, a new world first, with the first transplant of both hands and part of the forearms, on a 33-year-old house painter who was amputated after being seriously injured in the explosion of a home-made rocket. But until 2016, only six other patients then benefited from this double transplant, authorized on a case-by-case basis within the framework of the Hospices Civils de Lyon program.

In 2017, following in particular the case of Laura Nataf, France undertook to better define the legal and financial framework for this type of transplant.

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