WILL THE COSTS OF LIPOMA REMOVAL BE COVERED BY HEALTH INSURANCE?

Public Health Insurance:

Unfortunately, within our current German healthcare system, it does not matter whether one or 30 lipomas are removed in a single operation; the reimbursement remains the same. Therefore, such extensive cases can only be performed either through a special agreement with the public health insurance (GKV) or through separate private compensation. For this reason, we surgeons have to demand a great deal of understanding from our patients. This is also the reason why hardly any surgeon is interested in lipoma removals (they are usually complex to remove, but the reimbursement is always too low and completely independent of size and number). Consequently, economically conscious surgeons working with health insurance usually only remove one lipoma per quarter, as any additional effort would be provided "completely for free."

Private Health Insurance:

Private insurers claim to pay more, but they regularly downplay the complexity of these tumor removals. Even photographic, intraoperative, and postoperative documentation does not help here. This is because every removed lipoma immediately shrinks by at least one-third of its original size within the body, as it is detached from its connective tissue attachment inside the body and thus collapses.

The tactic of private health insurers is to question the number of (documented with photographs) removed tumors, downplay their size, and instead use billing codes for tumor size that are one step smaller, thus making significant savings at the expense of the operating surgeon. The insured person is "tactically suggested" that the doctor has overbilled, thus insinuating "fraudulent or exaggerated billing" without directly stating it. The preparatory formation of fat flap plasty to compensate for dimpling is doubted and removed. The medical bills are often cut down to one-third (or even less), and a "legal and moral defense line" is tactically built against the billing surgeon, while trying to pull the patient to the side of the health insurance with seemingly plausible arguments.

In this way, any effort by a surgeon to achieve the best possible surgical outcome is completely sabotaged. As a surgeon who gives everything to achieve the best possible surgical outcome, this is very painful for me. Usually, the reimbursement from private health insurance is not even sufficient to cover the basic costs of the performed operation. This is because the GOÄ (Fee Schedule for Physicians) was established in 1982, had a one-time fee adjustment of 3.5% in 1997, and has remained unchanged ever since, without any inflation adjustment. However, the sole inflation adjustment to the devaluation of the GOÄ since 1982 is, according to my own calculations (until 2023), more than 240%, disregarding numerous additional costs and quality requirements.

This means that privately insured patients who want to have their troublesome lipomas removed by us – without compromise, following the highest possible standards – must agree to a necessary preoperative fee agreement that is aligned with the finally required and accurately documented operating time. The surcharge factors must be appropriately increased, and analogous billing codes must be applied because the "ancient" GOÄ no longer includes any modern surgical techniques. I ask for understanding in this regard. Otherwise, as a doctor and surgeon, I can no longer compensate for the highly dramatic devaluation of the GOÄ while maintaining a consistently high standard of care.