Health insurance companies do not have to pay liposuction

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Verdict: Outpatient liposuction no cash benefit

The statutory health insurance companies are not obliged to finance liposuction. The Mainz Social Court decided this and dismissed a complaint from a patient. In the verdict, the Federal Joint Committee has not yet recognized outpatient therapy as a treatment method. For this reason, the health insurers do not have to cover the treatment costs even if it is a medically induced procedure. The woman now has to bear the costs.

Health insurance companies are not obliged to cover the costs of outpatient liposuction (liposuction). The judgment of the social court in Mainz (Az: S 14 KR 143/11). This also applies if the patient's fat tissue has increased due to an illness. Liposuction on an outpatient basis is still a new type of examination and treatment, as stated in the explanatory statement. This is only financed in the outpatient area if the Federal Joint Committee (GBA) considers such an intervention to be medically sensible and recommend it. So far, however, there has been no such recommendation from the experts. The GBA is responsible for determining the benefits for medical care in statutory health insurance.

In the present case, a plaintiff had liposuction performed on an outpatient basis. The woman was medically diagnosed with lipedema, which she has suffered from when she was young. The disease leads to a painful accumulation of adipose tissue. Neither sport, diet changes nor manual lymphatic drainage have so far been able to alleviate the suffering of those affected. When the plaintiff submitted a cost to the health insurance company, she refused to pay for the intervention.

There was also no special exception, which, despite the lack of a GBA recommendation, led to the health insurance company assuming costs. Such a case only exists if the insured are in a life-threatening situation and the disease in question often leads to a fatal outcome. Such a course is not known for lipedema. (sb)

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