Health Insurer Coverage Denial for Bimaxillary Setback Osteotomy Upheld

A claimant appealed the denial of coverage by a health insurer for a bimaxillary setback osteotomy intended to treat sleep apnea, arguing the procedure was medically necessary, while the lower court upheld the insurer's refusal to issue a cost guarantee for the basic compulsory health insurance. The court reasoned that for such a procedure to be covered under compulsory insurance when it is primarily orthopedic or orthodontic in nature, it must satisfy stringent criteria demonstrating that the treatment targets a severe, objectively verifiable functional impairment directly affecting vital bodily functions that cannot be adequately treated by less invasive or less expensive means, which were not sufficiently proven by the claimant in this case.