SERVICII MEDICALE PRESTATE ÎN ALT STAT MEMBRU ÎN BENEFICIUL UNEI PERSOANE ASIGURATE ÎN SISTEMUL NAŢIONAL DE ASIGURĂRI DE SĂNĂTATE. A DOUA OPINIE MEDICALĂ EXPRIMATĂ DOAR ÎN ALT STAT MEMBRU. ÎMPREJURARE EXCEPŢIONALĂ CIRCUMSCRISĂ ART. 20 ALIN. (2)...
MEDICAL SERVICES PROVIDED IN ANOTHER MEMBER STATE TO AN INSURED PERSON UNDER THE NATIONAL SICKNESS INSURANCE SCHEME. SECOND MEDICAL OPINION EXPRESSED ONLY IN ANOTHER MEMBER STATE. EXCEPTIONAL CIRCUMSTANCE COVERED BY THE SECOND SENTENCE OF ARTICLE 20

Summary/Abstract: If a patient insured under the Romanian sickness insurance system is in possession of a second medical opinion, by which he is prescribed treatment which could be applied under that system, if a doctor affiliated to that system were to prescribe it, the actual impossibility of the patient to undergo the second medical opinion to an effective examination by such a doctor constitutes a restriction on the freedom to provide services provided for in Article 56 TFEU. In the present case, the patient went to a Member State other than that of his residence, not so much because the treatment in question would have been better applied there, but only because he was prescribed there, i.e. because he did not have access to him in the Member State of residence, even if that State provided for it by its legislation, within the meaning of the first sentence of the second sentence of Article 20(2) of Regulation (EC) No 883/2004. The applicant’s author was unable to obtain authorisation under Article 20(2) of Regulation No 883/2004 because of the absence of a procedure whereby he could have submitted the second medical opinion, by which he was prescribed treatment which did not give rise to a disability, to an actual examination of a doctor of the Romanian social health insurance system, when his attending physician, affiliated to that system, prescribed him another treatment, which gave him a disability. The absence of such a procedure to ensure that a second medical opinion issued in another Member State is effectively taken into account, which recommends alternative treatment equally suited to that person’s state of health, but without the disadvantages of the first treatment, constitutes an exceptional circumstance which, in the light of the specific dates of the case, falls within the case referred to in the second sentence of Article 20(2) of Regulation No 883/2004.

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