Health insurance pays no compensation for hereditary missing female breast

BSG: Missing breast system "no illness requiring treatment"
Kassel (jur). The statutory health insurance companies must pay women without breasts no artificial breast. This also applies if this is due to a hereditary disease, judged on Tuesday, March 8, 2016, the Federal Social Court (BSG) in Kassel (Az .: B 1 KR 35/15 R). The missing breast system is "not a disease in need of treatment".

No chest op in missing breast since birth. Picture: resket - fotolia

Thus, the BSG dismissed a 31-year-old woman from Saxony-Anhalt. She suffers from Camurati-Engelmann syndrome, a hereditary bone disease. This led to a delay in puberty, which is why no female breast developed. The use of hormone preparations was unsuccessful.

At her health insurance, the AOK Sachsen-Anhalt, the woman requested to provide her with an artificial breast. The health insurance company refused this. There is no illness in need of treatment.

This was followed by the BSG. The creation of an artificial breast does not change the hereditary disease and can not produce the applicant's ability to breastfeed. That the breast is missing, is not a disease, but only affects the appearance of the woman.

The correction of a deviation from the usual body, the health insurance but only pay if it leads to functional impairment or severe disfigurement. Functional impairments would not exist here. A disfigurement must be so serious that it already attracts attention "almost in passing" and "regularly leads to the fixation of the interest of others". Again, this is not the case here.

The demand for equal treatment with breast cancer patients and transsexuals also remained unsuccessful. If one or both breasts have to be removed in a breast cancer patient, then it is then about to restore the previous state as possible. But here the plaintiff wants "a new state".

Transsexuals may be eligible for breast surgery if hormone treatments remain inconclusive. However, this is part of a comprehensive overall treatment and also of a difficult mental process. However, similar psychological problems were not found in the applicant. (Mwo / fle)