Ruling: A male cashier is not obligated to cover the costs of male breast reduction surgery
In a recent ruling, the Baden-Württemberg State Social Court in Germany denied a man's request for health insurance coverage for a breast reduction operation. The man, who has been suffering from gynecomastia, a condition where men's breasts enlarge to resemble a female breast, had previously appealed to the Stuttgart Social Court and the Baden-Württemberg State Court, but both appeals were unsuccessful.
The court reaffirmed that milder treatments like weight loss and physical activity are reasonable alternatives to surgery. Despite the man's reports of pain and psychological distress, the court referred to these milder measures for treatment of gynecomastia. However, the court did not find evidence to support the man's claims of severe pain.
Gynecomastia can cause physical pain, with the breast feeling tight, tender, and sensitive to touch. It can also cause psychological distress, leading individuals to withdraw from social life. The court stated that the man's psychological distress should be treated primarily psychologically, such as through psychotherapy.
The court's decision was based on Case No.: L 11 KR 3239/22. It's worth noting that insurance in Germany may cover gynecomastia surgery only when the condition causes significant physical symptoms or psychological distress and when less invasive treatments have failed or are unsuitable. Coverage limits and policies may vary by insurer and individual case, but up to €5,000 maximum coverage over long terms (e.g., 36 months) has been mentioned in contexts discussing German insurance for related treatments.
In daily life, no one would notice the man's enlarged breast in fleeting encounters. However, the court did not find any physical abnormality that constantly attracts attention, causing the man to withdraw and not participate in social life. There were no records of work absences, pain therapy, or prescribed pain medication.
The man's case was reported by the "anwaltauskunft.de" portal. Despite the denial of health insurance coverage for the breast reduction operation, the man can still explore other options such as paying out-of-pocket or seeking treatment abroad for cost reasons. Surgery to remove breast tissue can provide relief for individuals with gynecomastia.
- The court's decision regarding gynecomastia surgery emphasized that therapies and treatments like psychotherapy may be essential in addressing the mental-health implications of this condition, particularly in instances of psychological distress.
- While science has proven that certain health-and-wellness therapies can aid in managing gynecomastia symptoms, insurance providers in Germany may only cover surgeries when the condition causes significant physical or psychological impact and other treatments have proven unsuccessful.
- In the case of mens-health, evidence shows that gynecomastia can result in both physical discomfort and lasting psychological effects, warranting consideration of a multidisciplinary approach for treatment and symptom management that encompasses a variety of therapies and treatments.
