Dispute over breast implant health insurance does not have to pay

Dispute over breast implant: Health insurance companies do not have to pay

Breast augmentations are also enjoying increasing popularity in Germany. Unfortunately, the desire for the dream breastplate often puts the thoughts of possible side effects in the background. Only when the implants slip, the pain increases and the optimally prepared breast is only slightly changed in shape, many remember the original warnings.

Who pays for complications from breast implants?
But who pays when the once well-fitting implant becomes a health risk? And can a woman hope for an appealing renewal, or will the breast only be restored in a makeshift manner? The Rhineland-Palatinate State Court has now ruled in a corresponding procedure that the health insurance companies only have to take over the removal of the old implant if it represents a health risk. However, the costs of a new implant, which serves only the optical restoration of the breast, the cashes do not have to wear, so that judgment of the LSG (Az .: L 5 KR 59/10).

Plaintiff hoped for reimbursement by health insurance
The plaintiff in the corresponding case had undergone breast augmentation years ago, but had to have the breast implant removed because of massive pain. In the present case, she did not only seek the costs of removing the implant from her health insurance (she wanted to take over the insurance anyway), but also to claim for the implantation of a new breast implant.

Inserting a new breast implant medically not required
However, the judges at the LSG dismissed the woman's concerns with the argument that the use of the new implant was not due to illness and was therefore not medically necessary. Therefore, the cashier is not obliged to bear the corresponding costs. The fact that the health insurance company had paid for the breast augmentation at that time played no role in this context, so the verdict of the senate at the LSG. (fp, 30.09.2010)