Cashier Verdict: No Obligation for Male Breast Reduction Surgery Expenses
In a recent ruling, a court in Germany has decided against covering a man's breast reduction surgery, citing the lack of physical disfigurement and the availability of milder treatment options. The case, identified as L 11 KR 3239/22, was reported by "anwaltauskunft.de".
The man, who was suffering from gynecomastia—a condition where men's breasts enlarge to resemble a female breast—had applied for coverage based on the pain and psychological distress caused by his enlarged breast. However, the court found no disfigurement and suggested treating his psychological distress primarily with psychiatry, such as psychotherapy.
The man had previously undergone hormone therapy, which proved unsuccessful. He also presented no records of sick leave, pain therapy, or prescribed pain medication for his condition. The court acknowledged that gynecomastia can cause psychological burden and pain, but considered milder treatments such as weight loss and exercise as reasonable alternatives.
While alternatives to surgery for gynecomastia treatment exist, they are not widely accepted by courts as equivalent treatments when insurance coverage for surgery is denied. Medications for hormonal causes can be effective non-surgical treatments, but they apply only in select cases. Supplements and lifestyle changes have limited evidence and are not proven substitutes for surgery. Surgery to remove breast tissue can provide relief for gynecomastia, and it is the treatment recognized by courts for insurance coverage claims.
The man was unable to demonstrate medical necessity for surgery or show that non-surgical options had been exhausted without success. This decision highlights the challenges faced by individuals seeking coverage for treatment of gynecomastia, particularly when it comes to proving the need for surgery over other, less invasive options.
This ruling serves as a reminder for those affected by gynecomastia to seek comprehensive medical advice and to be prepared to provide strong evidence to support their case for insurance coverage for surgical treatment.
- Despite the man's application for insurance coverage, the court did not deem breast reduction surgery necessary due to the absence of physical disfigurement and the availability of psychoanalytic approaches for addressing mental health concerns, such as psychotherapy.
- The fact that gynecomastia can lead to significant mental health issues and pain was acknowledged by the court, yet they suggested that health-and-wellness alternatives, like weight loss and exercise, be prioritized over surgical intervention.
- The ruling on L 11 KR 3239/22 reinforces the difficulties people dealing with gynecomastia may encounter when trying to secure insurance coverage for surgery, highlighting the importance of well-informed decision-making and comprehensive medical evidence in these situations, especially regarding mens' health matters.
