No facial surgery for transsexuals

Social Court Heilbronn: health insurance does not have to pay for facial surgery for transsexuals

28/10/2012

A statutory health insurance company does not have to pay for chin, nose and eyebrow surgery for a transsexual patient, the Sozialgericht Heilbronn decided. Thus failed the plaintiff at the request to have the costs for a "female chin" financed by the fund in the amount of 4000 euros.

In the negotiated case, a transsexual was transposed from a man to a woman. "It is hurtful to be called a man," said the 40-year-old plaintiff in court. She was born as a female. Only the hormone testosterone caused that she had developed not as a woman but as a man. Because she felt "alienated in her own body," she had several medical interventions done to make her look like a woman. So the plaintiff was given a hormone therapy, the body hair was removed, the genitals were transformed and ultimately the Adam's apple was addressed. All previous interventions were paid by the health insurance without exception. But to complete the female image, the treating physicians proposed a "facial profile harmonization". With the interventions on the eyebrows, the nose and the chin, the face should be made more feminine. But the health insurance rejected the cost request in the amount of 4000 euros. Then the person concerned went to court.

Mental suffering attested by psychotherapist
Before the social court, the woman emphasized, "I do not want to be beautiful, but only corrected to know what the male hormones have caused". Only after the surgery, the transformation is complete and she can then live as a "normal woman". The treating psychotherapist of the plaintiff created a small opinion specifically for the court. In this the therapist emphasized the necessity of the intervention. "My patient suffers from a strong internal conflict". So far, there is no clear gender assignment by the striking-looking face, the therapist. If the face were not corrected, the mental suffering could manifest itself chronically. Another physician had emphasized the psychotherapist's argument with the argument that in the concrete patient case only the body can stabilize the emotional state, but not the psyche the body.

Approaching gender is achieved
The legal representation of the health insurance responded that cash had already paid over 50,000 euros for the sex change. According to § 12 SGB V, the health services of the statutory health insurance funds must not exceed the "measure of necessity". The already completed therapies and clinical interventions would have reached in the view of the fund "an approximation to the targeted sex". The requested surgery would also be an intervention in "healthy organs," argued the lawyer. However, health insurance companies are not obliged to finance operations for a better look. If non-transsexuals had the desire for corrections, that is, cosmetic surgery, the health fund would not pay for facial harmonization. "I can not treat her better than anybody else, that would be unfair," said the AOK representative in court.

Social Court dismisses action
The court confirmed the point of view of the cash register. The claimed surgery was an "aesthetic procedure and therefore a plastic surgery". However, such interventions have to be paid by insured persons themselves. Although initially there was no unambiguity of the case before, as a discussion between the judge and the assessors burned, ultimately seemed "the face of our opinion not so masculine that an operation would be justified," said court in the verdict. Health insurance companies only have to take over the conversion costs of transsexuals until a "clear approach to the actual gender is achieved".

No principle decision like
Although in this case the court ruled in favor of the fund, in principle it also gives a right to facial surgery for transsexuals, if necessary for the conversion. If the fund rejects a request, it must be decided on a case-by-case basis. A revision was approved. The plaintiff has already announced appeal appeal (file: Heilbronn Social Court, S 8 KR 2808 09).

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