Checkout Gastric reduction only after therapy

Health insurance companies have to finance a gastric reduction only after a therapy.

Health insurance companies do not have to accept the costs for a gastric reduction until all other therapies for reducing weight have been exhausted. This was decided by the judges of the Landessozialgericht Rheinland-Pfalz. Gastric reduction (gastric bypass) reduces food and fat intake through surgery.

The cost of surgical gastric reduction must first be borne by a health insurance company, when all other treatment options have been exhausted. The judges argued that the plaintiff plagued by obesity must first undergo at least six to twelve months of weight-loss therapy until a medical procedure can actually be carried out, which is then taken over by the health insurance. These treatments could be, for example, nutritional advice or conversion. The judgment was under the file number AZ. L 5 KR 101/10 published.

Earlier, the Social Court in Trier had given the plaintiff right. But the health insurance went into revision and the state social court reversed the previous decision again. In this particular case, a woman suffering from obesity asked the health insurance company to pay for a surgical reduction of the stomach. The medical gastric bypass surgery costs around 5400 euros. But the health insurance company refused to pay the costs, with the reference that not all therapeutic 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.

The judges, however, considered it proved that not all the previous measures had been taken to reduce the overweight. Although heavy obesity is a recognized disease, the judges ultimately gave the health insurance company the right. Also, the argument that the health insurance would not have sufficiently advised the applicant, dismissed the Regional Social Court. Finally, the health insurance is not obliged to, „unasked“ to point out qualified methods of treatment.

In gastric bypass surgery, the gastric volume is reduced by suture and the stomach is divided into two parts without a passage. After the procedure, a small stomach remains at the end of the esophagus. The operation reduces the digestion of fat to around 60 percent. The excess fat is then excreted again. Such surgery will result in early satiety and reduced food intake. (sb, 27.09.2010)

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Picture credits: RainerSturm