cashier not required to cover costs of male breast reduction surgery, court rules
In a recent case, a man in Germany sought coverage for a gynecomastia surgery from his statutory health insurance (SHI). However, his plea was dismissed by both the Stuttgart Social Court and the Baden-Württemberg State Social Court.
Gynecomastia, a condition where men's breasts enlarge to resemble a female breast, can cause psychological distress and pain. In this case, the man had been suffering from a benign enlargement of the breast glands for years. Despite this, hormone therapy failed as a treatment option, and the man claimed that the psychological distress did not justify the cost coverage for the operation.
The court's decision was based on the man's overweight status and the availability of milder treatment options for his gynecomastia. The court emphasised that primary treatment for psychological distress should be psychotherapeutic. Milder treatments like lifestyle changes are indeed considered reasonable initial steps before surgery is approved.
The court also did not find evidence of severe pain described by the man, as there were no records of sick leave, pain therapy, or prescribed pain medication. The court stated that milder treatment options for gynecomastia, such as weight loss and physical activity, are reasonable.
Despite the man's appeal, the court's judgment suggests that SHI generally covers gynecomastia surgery only if specific medical indications are met and conservative treatments, such as weight loss and physical activity, have been tried first and deemed insufficient. This aligns with procedures for other fat distribution issues, where insurance covers surgery only after non-surgical treatments fail.
The man's case was made public by the portal "anwaltauskunft.de". It serves as a reminder that SHI coverage for gynecomastia surgery is assessed on a case-by-case basis, and patients should consult their specific statutory health insurance providers to clarify individual eligibility and required documentation. Purely cosmetic interventions without a diagnosed medical necessity are usually not covered.
Surgery to remove breast tissue can provide relief for individuals with gynecomastia. However, it's crucial to exhaust all milder treatment options before considering surgery. The court's decision reaffirmed that gynecomastia is a disease, but it also emphasised the importance of considering milder treatment options.
[1] Source: German Statutory Health Insurance (SHI) Guidelines for Gynecomastia Surgery Coverage.
[1] The court's decision on gynecomastia surgery coverage highlights the importance of exploring mental-health therapies-and-treatments before surgical intervention, due to the psychological distress the condition can cause (mental-health).[2] In light of the court's judgment,SHI coverage for gynecomastia surgery is contingent on trying conservative treatments, such as lifestyle changes, weight loss, and physical activity, before considering surgery (health-and-wellness, therapies-and-treatments).[3] While men's health issues, like gynecomastia, may warrant surgical intervention, the court reinforced the need for exhausting milder treatment options first, as gynecomastia is recognized as a medically classified disease (science, mens-health).
