Health insurance companies only have to finance a stomach reduction after therapy.
Health insurance companies only have to cover the cost of gastric reduction when all other therapeutic options for reducing weight have actually been exhausted. That was the verdict of the judges of the Rhineland-Palatinate State Social Court. With a gastric bypass, the food and fat intake is reduced by a surgical intervention.
The cost of surgical gastric reduction does not have to be covered by a health insurance until all other therapy options have been exhausted. The judges took the view that the plaintiff, who is plagued by obesity, must first undergo at least six to twelve months of weight reduction therapy before a medical intervention can actually take place, which is then covered by the health insurance fund. These treatments could be, for example, nutritional advice or changeover. The judgment was filed under AZ. L 5 KR 101/10 published.
The social court in Trier had previously confirmed the applicant. But the health insurance company went into revision and the state social court overturned the previous decision. In this specific case, a woman who was plagued by obesity asked the health insurance company to cover the costs of a surgical gastric reduction. The medical gastric bypass surgery costs around 5,400 euros. However, the health insurance company refused to pay the costs, with the reference that not all treatment options had been exhausted. The patient weighs 115 kilos with a height of 1.71 meters. However, the person concerned made it clear that she had gone through all the attempts to reduce her excess body mass.
However, the judges saw it as proven that not all of the previous measures had been taken to reduce obesity. Although overweight (obesity) is a recognized illness, the judges ultimately agreed with the health insurance company. The State Social Court also rejected the argument that the health insurance company had not given the applicant sufficient advice. After all, the health insurance company is not obliged to refer to qualified treatment methods "without being asked".
In gastric bypass surgery, the stomach volume is reduced with the help of a suture and the stomach is divided into two parts without one pass. After the procedure, a small stomach remains at the end of the esophagus. The surgery reduces the digestion of fat to around 60 percent. The excess fat is then excreted again. Such an operation then leads to an early feeling of satiety and to a reduced food intake. (sb, 09/27/2010)
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