Health insurance does not pay for a replacement for a female breast that is inherited due to the inheritance

Health insurance does not pay for a replacement for a female breast that is inherited due to the inheritance

BSG: Missing breast system "no illness requiring treatment"
Kassel (jur). This also applies if this is due to an inherited disease, ruled on Tuesday, March 8, 2016, the Federal Social Court (BSG) in Kassel (file number: B 1 KR 35/15 R). The missing breast system is "in itself not a disease requiring treatment".

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

The woman applied to her health insurance company, AOK Sachsen-Anhalt, to provide her with an artificial breast. The health insurance company refused. There is no disease requiring treatment.

The BSG followed that. The creation of an artificial breast does not change the hereditary disease and cannot make the applicant breastfeeding. That the breast is missing is not a disease, but only affects the appearance of the woman.

Correction of a deviation from the usual body only has to be paid by the health insurance if this leads to functional impairments or to a severe disfigurement. There were no functional impairments here. A disfigurement must be so serious that it "catches the eye" and "leads to the fixation of other people's interests". This is also not the case here.

The demand for equal treatment with breast cancer patients and transsexuals was also unsuccessful. If one or both breasts had to be removed from a breast cancer patient, the next step was to restore the previous condition as far as possible. Here, however, the applicant wanted “a new condition”.

Transsexuals may be eligible for breast surgery if hormone treatments are unsuccessful. However, this is part of a comprehensive overall treatment and also a difficult psychological process. However, the plaintiff has not found any comparable psychological problems. (mwo / fle)

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