When the health insurance company pays – and when it doesn’t

On one condition

Cosmetic surgery: The health insurance company only pays in these cases

Rhinoplasty, breast enlargement, ear augmentation – cosmetic surgeries are in demand, but expensive. Health insurance companies only cover the costs in exceptional cases.

The desire for a better appearance leads many people to plastic or aesthetic surgery. But anyone who hopes that the health insurance company will cover the costs will usually be disappointed. Cosmetic surgery is generally not included in health insurance benefits – neither with statutory nor with private insurance.

An exception only applies if there is a medical indication – for example in the case of a deviated nasal septum with breathing problems, a breast reconstruction after cancer or in children with very protruding ears who are under psychosocial suffering.

Other cases in which health insurance can cover the costs of cosmetic surgery include:

• Tummy tuck if skin irritation or inflammation occurs after significant weight loss,
• Upper eyelid lift if the drooping eyelids restrict the field of vision,
• Liposuction for pathological fat distribution disorders that cannot be cured or changed through diet,
• Labia reduction due to proven impairment or dysfunction.

The medical service usually decides whether the health insurance company will pay after you have submitted an application to your health insurance company. Health insurance companies generally do not cover plastic-aesthetic procedures for purely cosmetic reasons. Read here which cosmetic surgeries are currently the most popular.

Anyone who has an operation without medical necessity not only bears the costs of the procedure, but also any subsequent costs themselves. If complications arise after the operation – such as wound healing problems or scarring – the statutory health insurance company does not have to pay. You can even claim back sick pay that has already been paid (Section 52 Paragraph 2 SGB V).

Tip: If you decide to have a voluntary operation, you should think about taking out follow-up cost insurance. This comes into play if large sums of money are incurred for follow-up treatments. But be careful: not all procedures or countries are insured – the small print counts.

• After major weight loss: How to get rid of an apron of fat

Another risk: Not every practice that offers cosmetic surgery is qualified. Because: The term “cosmetic surgeon” is not protected in Germany. If you want to be on the safe side, you should look for a recognized additional qualification – such as the designation “Specialist in plastic, reconstructive and aesthetic surgery”.

Ear, nose and throat doctors or oral and maxillofacial surgeons are also allowed to offer cosmetic surgery if they have the additional title “plastic and aesthetic operations” carry. Anyone who has invasive procedures carried out in cosmetic studios, on the other hand, risks making serious mistakes – because cosmeticians are not allowed to carry out operations.

Precisely because cosmetic surgery is not medically necessary, particularly strict information requirements apply. Doctors must explain all risks, possible failures and consequential damage. This also includes the note that the result does not have to be permanent.