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Heilbronn Social Court: Health insurance does not have to pay for facial surgery for transsexuals
A statutory health insurance company does not have to pay chin, nose and eyebrow surgery for a transsexual patient, the Heilbronn Social Court decided. The plaintiff failed because of the request to have the costs for a “female chin” financed by the health insurance fund in the amount of 4000 euros.
In the negotiated case, a transsexual had a man to a woman operated on for her. "It is hurtful to be called a man," said the 40-year-old applicant in court. She was born as a female being. Only the hormone testosterone caused her to develop not as a woman but as a man. Because she felt "strange in her own body", she had several medical interventions undertaken to look like a woman. So the applicant received hormone therapy, the body hair was removed, the genitals were converted and ultimately the Adam's apple was also straightened. All previous interventions were paid for by the health insurance without exception. However, in order to complete the female image, the treating doctors suggested a "facial profile harmonization". With the interventions on the eyebrows, nose and chin, the face should be shaped more feminine. However, the health insurance company rejected the application for costs in the amount of 4,000 euros. The victim then went to court.
Psychotherapist attests mental suffering Before the social court, the woman emphasized, "I don't want to be beautiful, I just want to know corrected what caused the male hormones". Only after the intervention was the complete transformation complete and she could then “live as a normal woman”. The plaintiff's psychotherapist prepared a small report especially for the court. In this, the therapist emphasized the need for the intervention. "My patient is suffering from a strong inner conflict". So far, there is no clear gender assignment due to the striking face, says the therapist. If the face were not corrected, the mental suffering could manifest itself chronically. Another doctor had accompanied the psychotherapist's argument with the argument that in a specific patient case only the body can stabilize the emotional state, but not the psyche the body.
Approach to gender has been reached The legal representation of the health insurance company replied that the insurance company had already paid over 50,000 euros for the sex change. According to § 12 SGB V, the health benefits of the statutory health insurance companies must not exceed the “measure of what is necessary”. According to the fund, the therapies and clinical interventions that have already been carried out would have “approached the targeted gender”. The proposed operations would also involve surgery on "healthy organs," the lawyer argued. However, health insurance companies are not obliged to finance operations to make them look better. If non-transsexuals had the desire for corrections, i.e. cosmetic surgery, the health insurance would not pay for facial harmonization. "I cannot treat her better than anyone else, that would be unfair," said the AOK representative in court.
Social court rejects lawsuit The court confirmed the view of the cash register. The claimed operation is an "aesthetic intervention and therefore a cosmetic operation". However, such interventions must be paid for by the insured themselves. Although the case was initially unclear, as a discussion also broke out between the judge and the assessors, "in the end, our face did not appear so masculine that an operation was justified," the court said in the reasoning of the judgment. Health insurance companies only have to cover the conversion costs of transsexuals until "a clear approximation to the actual gender is achieved".
No basic judgment is made In this case, the court ruled in favor of the health insurance fund, but in principle there was also a right to facial surgery for transsexuals if this was necessary for the conversion. If the cash register rejects a request, a decision must be made in individual cases. A revision was approved. The applicant has already announced that it will appeal (file number: Sozialgericht Heilbronn, S 8 KR 2808 09).
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