Transplant patient fighting for France to pay €1m US hospital bill

A French woman who underwent a double-forearm and hand transplant in the US is fighting to get her near-€1million medical bills charged to the French healthcare system.

Laura Nataf, 34, received the transplant in 2016 in a last attempt to seek treatment for the lasting impacts of septicaemia, which she developed at the age of 19. She said she had exhausted every option of a transplant in France.

Ms Nataf is now caught in a legal fight against the French national health insurance system over the bill from Penn Medicine, a private hospital network in Philadelphia.

She argues that the cost should be covered by the Caisse nationale d'assurance maladie (CPAM) due to her having no other option, a situation specifically covered in French law.

However, CPAM claims it offered a transplant solution to Ms Nataf and sent a letter citing it was against treatment in the US, which her lawyer contests.

“A letter of refusal is based on medical or operational reasons. The letter we were forwarded with no signature, no record, no motive and no advice from any medical professional,” said Valérie Sellam-Benitsy, Ms Nataf’s lawyer

Both parties have been summoned to an appeal hearing on January 5, 2023 after a first trial in 2021 ruled that the health insurance organisation was liable for payment.

The appeal was initially due this June but was postponed following late conclusions brought by CPAM before the judge.

While the CPAM was ordered to pay €664,000 during the 2021 trial, the appeal required Ms Nataf to include €322,507 in pharmaceutical and on-site costs, pushing the bill up to €986,507.

This is the first time the CPAM has been ordered to pay in such circumstances.

Septicaemia in Spain

Ms Nataf lost both her legs and arms after developing septicaemia while in Spain for an internship as part of her studies in the catering industry in 2007.

Doctors helped to facilitate her movements with prosthetic forearms and legs after she underwent amputations below the knees and elbows.

Read more: Organ donation in France: Why it is good to talk about it

She decided to seek treatments after watching a documentary about hand transplant. She turned to Laurent Lantieri, a French plastic surgeon and the director of the plastic surgery service at George Pompidou’s hospital in Paris who began to follow her case.

The CPAM agreed that Ms Nataf was eligible for a double-forearm and hand transplant in 2012 and she was added to a national list of patients waiting for treatments in February 2013.

In 2014, she was removed from the list and said that she was not given a reason for this.

She then decided to turn to the services of Scott Levin, chair of orthopaedics at Penn Medicine hospital, under the advice of Dr Lantieri, and received a transplant from a young woman who died in a car accident.

Referred to a Lyon hospital

Ms Nataf wrote a letter to the CPAM to let the organisation know of her decision and look for reimbursement, something the CPAM denies.

Ms Nataf’s argument is based on the 160-4 article from the French social security code, a specific rule that states that a patient’s medical bills should be covered by the French medical system when a medical solution that is not available in France is performed abroad.

The CPAM told The Connexion that Ms Nataf went to the United States to seek treatment while the national health system had advised her to go to the Hospices civiles’ hospital in Lyon.
The Hospices civiles’ hospital is renowned for its transplant services; it is the world’s first hospital to have transplanted a hand in 1998 and 2000 and the first French hospital to have transplanted a kidney in 1965.

The CPAM said Ms Nataf did not choose the transplant option in Lyon, a refusal the CPAM sees as a reason not to take on the cost of medical treatment in the US.

“I want to give patients back their voice so they can fight against the arbitrary power of the French healthcare system,” said Ms Sellam-Benitsy, adding that the court’s 2021 ruling in favour of Ms Nataf “set a precedent.”

She is now looking to bolster her defence and hopes more cases backing up her position will be brought to the judge in the meantime.

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