Unused psychotherapy sessions cannot be carried forward

ATA/146/1998Cour de justice / Chambre administrative17 mars 1998Dismissed

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Résumé Omnilex

The case concerns reimbursement of psychotherapy sessions under the OPAS. The court held that the regulation establishes a progressive reduction in the number of reimbursable sessions over several years and does not allow unused sessions from one period to be transferred to the next. The claim based on carry-over was therefore rejected.

Regeste Omnilex

OPAS art. 3; psychotherapy reimbursement schedule and carry-over of unused sessions: the ordinance establishes a period-based and progressively reduced entitlement to reimbursed sessions. Sessions not consumed within the relevant period lapse and may not be transferred to a subsequent period, absent an express legal basis. A contrary interpretation would defeat the staged limitation and the regulatory purpose of controlling treatment economy.

Texte intégral

Descripteurs

AM; PSYCHOTHERAPIE; ECONOMIE DU TRAITEMENT; ASSURANCE SOCIALE; ASSU

Normes

OPAS.3

Résumé

L'OPAS prévoit la réduction progressive, sur plusieurs années, du nombre de séances de psychothérapie remboursées. Le report de séances non effectuées durant une certaine période sur la période suivante n'est pas admissible.

Mots-clés

psychotherapyinsurance coveragetreatment economysession limitscarry-oversocial insurance

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Questions juridiques clés extraites par Omnilex

Question juridique clé

Whether unused psychotherapy sessions from one period may be carried forward to the next reimbursement period under OPAS Article 3.

Solution extraite

No. The progressive reduction scheme does not permit carrying over sessions that were not used during the relevant period.

Motifs extraits

The court held that the OPAS regime fixes the reimbursable number of sessions by period and provides for a gradual reduction over several years; allowing carryover would contradict that staged limitation.

Unused psychotherapy sessions cannot be carried forwardGénéré par IA