Cosmetic surgery: health insurers rarely cover the costs

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Written By Kampretz Bianca

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Cosmetic surgery is usually not medically necessary. However, if you still decide to do this for personal reasons, there are some things you should pay attention to.

The essentials in summary:

  • Legal health insurers only cover the costs of cosmetic surgery in exceptional cases.
  • Doctors who have additional recognized qualifications for aesthetic operations can be identified by the designation “Specialist in Plastic and Aesthetic Surgery”. Doctors of otorhinolaryngology and oral and maxillofacial surgery may have the additional title “Plastic and Aesthetic Operations”.
  • There is a special obligation to provide information: According to case law, doctors must provide accurate information about all risks.
  • Special care is required when undergoing cosmetic surgery abroad.

Cost of cosmetic surgery

For cosmetic operations that are not medically necessary, Legal health insurance companies do not cover any costs. Depending on the procedure, these are quite high. In some cases, the procedures also result in additional necessary operations and costs.

If complications arise after an operation that is not medically necessary and requires additional medical treatment, the statutory health insurance company must contribute an appropriate amount of the costs to the insured and deny or claim sickness benefit for the duration of this treatment, in the in whole or in part (Section 52 Para. 2 SGB V).

Cosmetic surgery: how do I recognize qualified doctors?

Most cosmetic operations are performed by plastic surgeons, dermatologists and gynecologists. O The term “cosmetic surgeon” is not protected by law, as there is no public law qualification for this by medical orders. Doctors who have additional recognized qualifications for aesthetic operations may be identified by the designation “Specialist in Plastic and Aesthetic Surgery” or by the additional designation “Aesthetic and Plastic Operations”.

But be careful: Even doctors without this additional qualification and without trained medical personnel can offer cosmetic operations. Many beauticians also offer beauty treatments. However, they are not allowed to perform invasive procedures. Furthermore, even seemingly small interventions can cause harm if carried out inappropriately. So, keep your eyes open when choosing the person who will treat you!

Plastic operations as a health insurance benefit

Plastic surgery may be covered by health insurance if Limitations of a function or one severe psychological suffering in cases of disfigurement. To do this, you must submit an application to the health insurer and this is normally followed by an examination by the medical service.

Examples of plastic surgeries whose costs are covered by health plans:

  • Rhinoplasty for respiratory obstruction
  • Protruding ears in children lead to psychosocial problems
  • Breast restoration after breast cancer and in case of breast malformations
  • Elimination of abdominal fat aprons in treatment-resistant intertriginal eczema

Physicians’ responsibility and special disclosure duty

The same liability rules apply to doctors who perform cosmetic surgery and other medical professionals, sometimes in a more stringent manner: As there are generally no medical reasons for intervening on the body of the person being treated, more stringent requirements apply. strict Obligation to provide information of doctors than in medically justified operations.

You must inform the person seeking help relentlessly and clearly about all the risks associated with the procedure, including possible aesthetic flaws and the risk of post-operative disfigurement. This also applies to the effects actually expected.

The person being treated must do this at least 1 day to think about it be left. Advertising for cosmetic surgery aimed primarily or exclusively at children and young people has been banned since 2020 (Measles Protection Law). This also applies to advertising on social media.

Doctors are responsible if they use surgical methods that they are not trained in and therefore do not have sufficient mastery of. They can also be held liable if they use methods that no longer correspond to the state of the art. Beauticians are not allowed to give anti-wrinkle injections.

There are several fundamental decisions on this subject, for example that of the Higher Regional Court of Münster from 2006 and the Higher Regional Court of Karlsruhe of February 17, 2012. Hyaluronic acid is also a medical product in the highest risk class 3 – an implant passport must be issued for this so that it can subsequently be tracked which product which manufacturer injected it under the skin.

If problems arise after a procedure and a treatment error is suspected, patients can inspect the patient record (§ 630g BGB) and make copies of it. This makes it possible to identify possible documentary deficiencies and speed up the work of any legal representation that may be appointed.

If you are not sure whether there has been a processing error, you can usually contact us free of charge Expert committees and arbitration boards in medical associations turn around.

Aesthetic plastic surgery doctors often use contracts that regulate services, rights and remuneration. O Liability cannot be excluded contractually. The situation is different when patients waive their claims after a failed cosmetic operation due to payment of compensation or after an offered surgical correction.

Cosmetic surgery abroad

Cosmetic surgeries are often offered abroad at significantly cheaper prices. However, you must be careful. The quality of services offered and medical standards can hardly be assessed in advance. Due to geographic distance, follow-up treatment is often difficult or not offered at all.

Anyone planning an operation abroad should therefore find out about both the medical qualifications and the quality standards of the clinics. Furthermore German law does not automatically apply. If an operation abroad fails, you cannot automatically hold the clinic responsible – and you will incur high follow-up costs. The guarantee – for example in the event of complications – must therefore be guaranteed before processing in writing, if possible in accordance with German law be determined. To do this, it is essential to conclude a private treatment contract with the foreign doctor and/or clinic.

About what you Medical visits and hospital admissions abroad If you need to know, read the linked article.

Tips for dealing with cosmetic surgery

Before the procedure

  • Ask at Query about possible side effects, risks and complications and ask for them to be explained in detail.
  • Check with your health insurer to see if they have this Cost of cosmetic surgery takes on. However, this is only possible in the rarest cases and when there is a medical need. It is advantageous to contact the health insurer directly with the help of a statement from the treating doctors.
  • Ask if this Result of the intervention it is permanent or time-limited and therefore may have to be repeated.
  • Find out which Qualifications the doctors responsible for the treatment and how often they have already performed the planned procedure.
  • Additionally, you must guarantee in writing leave it the consultant also takes over the operation and not other doctors who may be unknown to you.

In consultation

  • If possible, get one person testifying and prepare basic questions about the planned operation. In the preliminary discussion, the successes of a procedure are often praised and accompanied by corresponding glossy photos as proof, while possible risks are not adequately pointed out. If the risks are not sufficiently discussed, the doctor is liable in the event of damage, even if no other mistakes were made. If any questions remain unanswered after the first consultation, they should be clarified in a second or third consultation.
  • So much so Operation procedure just like this Healing process and the risks must be clearly explained. The question of which one is also important Care in case of emergency can be offered. It makes sense to inspect treatment rooms beforehand.
  • You should not sign a treatment contract during your first consultation. Reputable doctors will give you the opportunity Review the contract calmly and get other offers for comparison.
  • Make sure you get one before signing a contract various offers and compare prices.
  • Be sure to request one after your appointment detailed cost estimatewhich, in addition to the costs of the operation, also provides information on costs for anesthesia, laboratory, accommodation and aftercare.
  • Dispose no advance payments.
  • Ask for Copies of records and photoswho can document the course of treatment or surgery.

After the procedure

  • Depending on the severity of the medical procedure, the Aftercare the most important. This must therefore be guaranteed by the operating physician.
  • Insist on a correct Invoice based on fee schedule for doctors (Go).
  • Wait for a failed intervention Don’t wait too long for the changes that are yet to occur. Get advice from other doctors.
  • Customize one Event logging secure the addresses of witnesses – for example, those in your room – and document the situation with your own photos.
  • After a failed operation It is advisable to conduct negotiations only with the person treating you or the responsible insurance company with legal advice.
  • they should in no way a waiver sign or something similar.

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