Transsexual cash register has to pay for breast surgery

Health insurance companies have to pay for breast augmentation in transsexuals

12/09/2012

The Federal Social Court in Kassel has granted a lawsuit by two transsexuals. People who are transsexual are entitled to reimbursement from their health insurance company for covering the costs of clinical breast augmentation, the judges said. Finally, transsexuals make an exception under certain conditions. It is crucial whether a previously taken hormone treatment achieved little to no effect.

"Does breast augmentation only come into question specifically in male-to-female transsexuality if either sex-matching surgery with the removal of the male gonads has not led to an acceptable growth of the breasts or if a sex-adjusting surgery is not to be carried out?" today went to the Federal Social Court in Kassel and decided in favor of the applicants.

Man-to-woman transsexuality eligible for breast augmentation
If women want to do a breast augmentation for aesthetic reasons, they have to pay the costs out of their own pocket. A breast surgery with implants does not belong to the service catalog of the legal health insurance, so the usual jurisprudence. As the Federal Social Court in Kassel today ruled, transsexuals (man to woman) in principle have a claim to the financing of a medical breast augmentation, if the minimum targeted size of the body was not reached by a hormonal treatment. However, this was the prerequisite that the hormone therapy so far not struck and also not at least the body size A was reached, as judged by the supreme social justice.

The judges based their opinion on the fact that the legislator has recognized an absolute exception regarding transsexuality. For the "reduction of the mental suffering" of the person concerned, this treatment claim exceptionally also in an "intervention in healthy organs". In addition, the judges emphasized that a previous conversion of the sex organs was not necessary for the claim (file reference: B 1 KR 9/12 R and B 1 KR 3/12 R).

Cashier refused to pay the cost of the surgery
The court dealt with two cases. In the first, the health insurance company had taken over the therapy costs of a 62-year-old plaintiff for a hormone treatment as well as the conversion of the genitals. Because, however, despite the administration of hormones only very small breasts had formed, the woman applied for the cost of implant surgery for the plastic production of a female breast. However, the operative breast augmentation was rejected by the cash register. The health insurance argued that an "operation on healthy organs" can not be found in the catalog of benefits of the statutory health insurance. Therefore, such "cosmetic surgery" is basically not funded.

In the second case, the fund had already paid for hormonal therapy, surgical feminization of the face, and two interventions to change the height of the voice. The assumption of costs for the removal and conversion of the reproductive organs had already been approved, although not yet claimed by the plaintiff. Again, the cashier refused to pay a breast augmentation. However, the fund argued that the genital surgery could also be a hormonal transformation, which leads to an enlargement of the breast. Therefore, this operation should be first preceded before decided on a breast surgery.
Breast surgery if body size A was not reached by hormone administration
Both arguments were rejected by the supreme social justice. Because the legislator regards transsexuality as an exceptional position, the health insurance companies must, under certain conditions, also finance a transformation of the breast, even if it is an actually healthy organ. This verdict, however, applies only if the size of the body A, for example, has not been reached by the administration of hormones.

If the breast size has already been reached, it is an "unquestionably gender-typical area". Then there was no longer a claim for funding from the fund. Therefore, the first lawsuit was again referred to the Landessozialgericht Hessen for re-examination.

Genital surgery no requirement
In the second case, the federal social judges decided that the health insurance company may not demand a previously undertaken conversion of the genital organs. The Federal Social Court referred in its verdict to a previously pronounced judgment of the Federal Constitutional Court. Therefore, it is no longer necessary for a name change to have a solccurioshe operation. (Sb)