Photo: DPA

Court rules insurance must pay for ex-soldier's breast surgery

Published: 22 Oct 09 09:09 CET
Online: http://www.thelocal.de/society/20091022-22739.html

A transsexual has won a lawsuit against her German health insurance, which will now have to pay for the former British soldier's re-constructive breast surgery, news magazine Der Spiegel reported late on Wednesday.

Sarah Jane Smith, 51, has been living as a woman since she began the sex change process three years ago in Hannover. But the hormones prescribed by her doctor made her breasts grow from the side of her chest, the magazine reported.

She suffered so greatly from forcing her breasts into corsets and bras that Smith applied to have a corrective operation with the DAK health insurer, with which she has been insured since 1998.

But DAK refused to pay for the €6,000-operation.

Smith took the case to court, and the judge ruled on Wednesday that DAK would have to pay for the surgery.

According to a DAK spokesperson Jörg Bodanowitz, German insurance oversight organisation MDK found that Smith fulfilled the same criteria as a born woman.

“And this examination showed that there is actually a case of malpositioned breasts,” Bodanowitz said, adding that the DAK would follow the recommendation to operate.

According to Der Spiegel Smith discovered her will to be a woman at an early age, and after marrying a German woman used every opportunity alone to dress in female clothing. She divorced in 2003.

The Local (news@thelocal.de)

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15:01 October 22, 2009 by Monty Clift
That's what happens when you tamper with mother nature.And wouldn't it have made more sense to stop taking the female hormones so that you would return to your normal body type? These cases all sound more like some psychiatric disorder than an error of developement. And why would he wait until 50 when he only has 20 or so years left to live on average anyway to begin all this "sex change" nonsense? Total insanity.
15:07 October 22, 2009 by habitual_line_stepper
This is unacceptable. I am guessing that the hormones this guy took to become more womanly were paid for by insurance? Nothing that is not a medical necessity should be paid for by insurance. Ever. Those hormones shouldn't have been - and maybe they weren't. But no matter what, this person made a conscious decision to have an elective alteration to their body and that should come out of their own pocket and any problems that result should come out of their own pocket, too. Guess who ends up footing the bill for this. Premiums are high and probably will be no matter what, but stuff like this makes them higher.
15:09 October 22, 2009 by Buffy
This is unacceptable. I am guessing that the hormones this guy took to become more womanly were paid for by insurance? Nothing that is not a medical n…
Well, I haven't formulated my whole opinion on this story yet but this statement kind of hit a nerve because the health insurance doesn't even pay the creams my daughter so desperately needs to control her unsightly eczema.
15:53 October 22, 2009 by habitual_line_stepper
There is a big difference between a kid with eczema and a 50 something year old man that decides he wants to take hormones because he feels like a woman and sues the insurance company later because it all went wrong. There are plans that cover the cost of eczema medication. It will cost more because it is a pre-existing condition. And it will cost more because the companies cover the losses they take on things like this story by passing the costs on to the rest of us.
16:11 October 22, 2009 by LeonG
For what I know about Gender Identity Disorder, there is no way to fix the brain to make the person want to be man if she wants to be a woman. In the past, they've tried psychotherapy, hypnosis, praying and I don't know what else. Some parents have beaten their kids for being like this and it also didn't help.

When people say that these people should have psychotherapy rather than hormones and surgeries, guess what, if they are getting the hormones and surgeries in the first place, they would have already had the psychotherapy and it didn't work.

As for it being a medical necessity or not, many of those people are very depressed and dysfunctional so choosing not to fix them means they'll cost you instead with their depression while if they get their hormones and surgeries, most of them seem to cope pretty well.

As for figuring this out at age 50, that's maybe a bit late in the day but don't forget that this person would have grown up in a time when it was not ok for boys to dress up like girls and probably tried to hide it and managed really well hiding it for some decades. Had society been more tolerant then, she might have come out much earlier.
16:43 October 22, 2009 by IrishEyesAreBlue
It still looks like a man! Even with tons of make-up - and size 60 KKKK boobs - it still looks like a man - because it IS a man! This poor soul needs counseling -- this is a mental disorder. Period! End of story! Over and out!
17:44 October 22, 2009 by muFFin09
I think people should live how they wish too whether man or woman, no-one has the right to judge anyone else, if a man is happy in a woman's body then so be it 'that's life' and life is for living, I am a straight frau open to everything life is far too short to complain about what others make so if it doesn't disturb your life then you need to shut the hell up until you know what it's like to change gender it's certainly not taken lightly, every damn human being has a skeleton in their cuboard so think before you shout your mouth off about others gay or otherwise, I am a jock and open for everything....
18:26 October 22, 2009 by D R Jones
muFFin09, I don't care if you're gay, straight or transgendered. It disturbs my life because those premimums I pay support this type of surgery. It also keeps taxes rising to support these services. That money is better spent on a child that has problems that aren't elective. Why should I pay because you're ugly and want plastic surgery so you can get laid more often? You have the right to be and do anything you want, as long as it doesn't affect my wallet.
18:46 October 22, 2009 by Binaural
It still looks like a man! Even with tons of make-up - and size 60 KKKK boobs - it still looks like a man - because it IS a man! This poor sou…
Man, the standard of Toytown is really going down with the recent influx from the Local.
20:36 October 22, 2009 by delvek
"That's what happens when you tamper with mother nature."

true statement.

"This poor soul needs counseling -- this is a mental disorder."

agreed.
14:39 October 24, 2009 by habitual_line_stepper
I'm sure there are plenty of real women who develop psychological issues because they have small breasts. That doesn't mean that insurance should pay for breast implants. If this person was psychologically traumatized (the story doesn't say that, but clearly there are those who will assume this to be true) by feeling like a woman in a man's body, I am sorry for them. But a lot of people suffer from things they can't change about themselves without surgery, etc. That does not mean that insurance should pay for it. Insurance was originally intended to pay for major losses, not for every little thing the way we expect it to now. And for the record, I think insurance companies are evil as far as most of their practices go. The person in this story has every right to live their life as a man or woman, but they do not have the right to expect insurance to pay for what they need to make them feel better. Nor should insurance pay to clean up the mess they created themselves.
09:11 October 25, 2009 by oopster
The big issue here seems to be "I don't want my insurance premiums paying for this 'man' to become a woman, he chose this", well guess what, SHE didn't choose this. This is a medical condition where the brain and the body don't match, and the only known way to correct the situation at this point in time is surgery to bring the body in line with the brain.

If you want to ban all medical procedures based on what people choose to do in order to lower your insurance premiums then you have to do it for everyone, that means anyone with cancer who smoked, sorry, you've no longer covered, you CHOSE to smoke. Anyone with kidney problems who drinks alocohol, sorry, you're no longer covered as you CHOSE to drink. Anyone getting pregnant who CHOSE to get pregnant, sorry, but you CHOSE to get pregnant.
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