Health insurance companies do not have to pay liposuction

Verdict: Outpatient liposuction no cash benefit

28/04/2012

The statutory health insurance companies are not obliged to finance a liposuction. This was decided by the Mainz Social Court and dismissed a complaint from a patient. The verdict stated that the Federal Joint Committee has not yet recognized outpatient therapy as a treatment method. For this reason, the health insurances do not have to bear the costs of treatment, even if it is a medically induced intervention. The woman now has to bear the costs herself.

Health insurance companies are not obliged to cover the costs of outpatient liposuction (liposuction). The verdict of the Social Court in Mainz (Az: S 14 KR 143/11). This also applies if the fatty tissue in the patient has increased due to a disease. The outpatient liposuction is still a novel examination and treatment method, as it says in the explanatory statement. This will only be financed in the outpatient sector if the Federal Joint Committee (GBA) considers such an intervention medically sensible and recommends it. So far, however, such a recommendation of the experts is not available. The GBA is responsible for determining the benefits of medical care in the statutory health insurance.

In the present case, a plaintiff had ambulatory liposuction. The woman was diagnosed with lipoedema in the woman she has been suffering from since her youth. The disease leads to a painful accumulation of fatty tissue. Neither sports, diet changes nor manual lymphatic drainage have so far relieved the suffering of those affected. When the plaintiff filed a reimbursement at the health insurance company, she refused to pay.

A special exceptional case was also not available, which despite the absence of GBA recommendation leads to a reimbursement by the health insurance. Such a case exists only if the insured are in a life-threatening situation and the present disease leads too often to a fatal end. Such a course is not known for lipoedema. (Sb)

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Picture: Martin Büdenbender