Application on holiday health insurance does not have to pay liposuction

Cash register does not have to pay: No approval fiction in liposuction

If a health insurance company does not process an insured person's application in time, it is actually considered approved. However, this legal regulation must not lead to abuse of rights, a court ruled. The verdict was due because a woman wanted to get a liposuction granted.

New legal regulation must not lead to abuse of rights

If a health insurance company does not process an application on time, it is considered approved. However, this new legal regulation must not lead to abuse of rights, has now decided the State Social Court (LSG) Lower Saxony-Bremen in a judgment published on Monday. In the negotiated case, the Techniker Krankenasse (TK) had informed a 53-year-old woman from the Osterholz (Lower Saxony) district that she was not paying her liposuction, as this was not an approved treatment method.

In a court ruling, a health insurance company was granted that had not approved an insured person's liposuction. (Image: BillionPhotos.com/fotolia.com)

Fat deposits in arms and legs

As the court writes in a communication, the woman suffered for many years from increased fat deposits in the arms and legs; at a height of 1.68 meters, it weighed 87.5 kilos.

After the health insurance had announced in an ongoing opposition proceedings that a liposuction (liposuction) is not an approved treatment method and therefore not paid, the woman made a second application.

This time but during a holiday trip on the island of Jersey / Great Britain at the German Honorary Consulate for forwarding to the cashier.

A few weeks later, she filed an express petition in court. Due to the "frightening progression" of the disease picture, the liposuction must now be done very quickly.

She had received no reply to her second application within the processing period, so that in her opinion the approval fiction had occurred.

Requirements for an urgent procedure

However, the LSG was unable to agree with the legal opinion of the applicant.

According to the communication, the conditions for an urgent procedure are serious and unreasonable and irreversible disadvantages which can not be remedied by waiting for a decision on the substance of the case.

Increased perceived discomfort in the legs after a flight to a holiday island would not meet these requirements. In addition, the approval fiction had not legally occurred.

The endeavor to obtain an approval fiction from an alleged application filing at a German consulate abroad limits even legal abuse.

Although an application can in principle also be submitted through a consulate. However, the time limits for the approval fiction could not apply in their sense and purpose from the moment they are submitted. (Ad)