Dispute over breast implant: Health insurance companies do not have to pay
Breast enlargements are also becoming increasingly popular in Germany. Unfortunately, the desire for the dream size often leaves the thoughts of possible side effects in the background. Only when the implants slip, the pain increases and the optimally prepared breast can only be perceived with a slight change in shape, do many remember the original warnings.
Who pays for complications from breast implants?
But who pays when the once well-fitting implant becomes a health risk? And can women hope for an appealing renewal or is the breast only needing to be restored? The State Social Court of Rhineland-Palatinate has now ruled in a corresponding procedure that health insurance companies only have to remove the old implant if it poses a health risk. However, the health insurers do not have to bear the cost of a new implant that only serves to visually restore the breast, so the LSG ruled (file number: L 5 KR 59/10).
The plaintiff hoped that health insurance would cover the costs
The applicant in the corresponding procedure had undergone breast augmentation years ago, but had to have the breast implant removed due to massive pain. In the current proceedings, she tried not only to pay the costs of removing the implant from her health insurance company (which the insurance company wanted to cover anyway), but also to cover the costs of inserting a new breast implant.
Medically not required to insert a new breast implant
However, the judges at the LSG rejected the woman's concern with the argument that the use of the new implant was not disease-related and therefore not medically necessary. Therefore, the fund is not obliged to bear the corresponding costs. The fact that the health insurance company had paid for the breast augmentation at that time did not play a role in this connection, according to the decision of the Senate at the LSG. (fp, 09/30/2010)