The Court determined that it neglected to scrutinize whether the support aligned with the principles of the common market.
In a recent case, a man suffering from gynecomastia, a condition that causes a male's chest to resemble a female breast, had his health insurance refuse to cover the costs of an operation. The man took his case to the Social Court of Stuttgart, but his complaint was dismissed. He then appealed to the Baden-Württemberg State Social Court, but his complaint was also dismissed.
Gynecomastia can cause psychological burden and pain, and in some cases, surgery to remove breast tissue can provide relief. However, health insurance may not cover the procedure, and coverage criteria vary widely by insurer and policy.
The court in this case stated that there was no disfigurement from the enlarged chest, as it is common for enlarged breasts to be present in adipose men and would not be noticed in a fleeting encounter in everyday life. The court also referred to milder measures for treatment as a reason for denying coverage for the breast reduction surgery.
The man had been experiencing the condition for years and had tried unsuccessful hormone therapy. The court determined that the man's psychological distress does not justify coverage of the operation and suggested treating it primarily psychologically, such as through psychotherapy.
The court did not find evidence of severe pain described by the man, as there were no records of sick leave, pain therapy, or prescribed pain medication. The man's case serves as a reminder for those affected by gynecomastia to check directly with their health insurance provider and work closely with their surgeon’s office to obtain required documentation and understand the insurer's specific requirements.
For those who may not qualify for insurance coverage, financing options or seeking surgery in countries with lower costs, such as Turkey, Mexico, Thailand, or parts of Europe, are common alternatives. Non-surgical alternatives include observation, discontinuation of causative medications or substances, and medical therapy if a treatable underlying cause is identified, though such therapies are limited in efficacy for longstanding cases.
- Surgery for gynecomastia, a medical condition that can cause psychological distress, may not be covered by health insurance, as the case in Stuttgart demonstrated, with the court denying coverage due to insufficient psychological distress and the possibility of milder treatment methods.
- When dealing with issues related to health and wellness, such as fitness and exercise, mental health, or medical conditions like gynecomastia, it's crucial to directly consult with insurance providers to understand their coverage criteria and requirements.
- For individuals who might not qualify for insurance coverage for gynecomastia treatment, alternative options may include financing, seeking surgery in countries with lower costs, or exploring non-surgical alternatives like observation, discontinuation of certain medications, or medical therapy, despite their limited efficacy in longstanding cases.
