Supreme Court: Insurance Companies Cannot Directly Bill Hospitals for 'Mammotome Procedure Fees'

The Supreme Court has ruled that insurance companies cannot directly recover the indemnity insurance payments for 'Mammotome procedures' paid to hospitals from the hospitals themselves.

The Supreme Court's Second Division (Presiding Justice Min Yu-sook) announced on the 19th that it upheld the lower court's ruling, which dismissed the appeal filed by Insurance Company A against Doctor B in an unjust enrichment refund lawsuit.

Patients insured by Company A underwent Mammotome excision surgery (excision of benign breast lesions using a vacuum-assisted device) performed by Doctor B and subsequently claimed and received indemnity insurance payments from Company A. The total insurance payments made by Company A amounted to approximately 80 million KRW.

In response, Company A filed a lawsuit against Doctor B starting in 2019, arguing that the Mammotome excision surgeries performed by Doctor B were non-reimbursable elective treatments and demanded the return of the medical fees deemed unjust enrichment.

Both the first and second trials ruled that the insurance company could not claim unjust enrichment from the doctor, dismissed Company A's claim, and rejected the damages claim on the grounds that Doctor B had no obligation to the insurance company.

The Supreme Court also agreed with the lower courts' decisions. Previously, the Supreme Court Grand Bench ruled that, barring special circumstances, insurance companies cannot directly demand the return of medical fees from hospitals on behalf of patients.