Many people are unhappy with their bodies in one way or another. Over time, this dissatisfaction begins to negatively affect everyday life. Then the time has come for many people when they want to take targeted action against their “problem areas”. Surgical intervention is one way to achieve lasting results. But which cosmetic surgeries are covered by the health insurance and which requirements do patients have to meet?
What does medical necessity mean?
In order for the health insurance to take over an aesthetic operation, it must be “medically necessary”. This is the case when the patient is no longer able to cope with everyday life or can only do so to a very limited extent due to his or her physical situation. Reasons for this can be, for example, severe pain, recurring infections, breathing problems or disturbing malformations.
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Psychological restrictions are also considered medically necessary. If a patient suffers mentally from his physical situation (for example due to deformed breasts, protruding ears or gynecomastia), then this can justify the assumption of the costs for the insurance company.
Before cosmetic surgery is approved by the health insurance company, the medical indispensability must be confirmed by the attending physician and an independent expert. Only then will the insurance company cover all or part of the surgery costs. The decision to assume the costs is made individually in each case.
Which cosmetic surgeries does the health insurance company pay for?
There are a number of interventions that are approved by the health insurance company if the requirements are met. These are mainly breast, face and skin operations, as well as liposuction.
Breast surgery
Breast surgery is one of the most frequently approved procedures. Most often breast reductions and breast reconstructions are performed.
- Breast reduction (woman): Very large breasts have been shown to cause physical discomfort and pain in the shoulders and spine. Surgical breast reduction can help here.
- Breast reduction (man): Gynecomastia (a strong enlargement of the man’s breast) can severely restrict the everyday life of men. The signs of gynecomastia are easy to recognize. If the cause is hormonal, liposuction is usually covered by health insurance.
- Correction of breast malformations: Deformations of the female breast can be psychologically very stressful for the patient and also cause physical complaints. In many cases, an operative correction is paid for by the health insurance company.
- Breast reconstruction: After cancer treatment or an accident, breast reconstruction may be necessary, the costs of which are usually covered.
As with all aesthetic interventions, breast surgery always decides on a case-by-case basis whether and how much of the total costs will be covered by the insurance. The medical reports are decisive here.
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