Peer Support Group for Trans*Persons in Hamburg

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Hair removal at the cosmeticians

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Medical Considerations

MDS Assessment Guide/ Begutachtungsanleitung des MDS
(Understanding MdS, MdK and statutory health insurance funds)

Coverage of medical treatment for trans*persons in Germany will always be approved (or not) by public health insurances on a case-by-case basis. Public health insurance staff decisions will generally be supported by an expert opinion from the competent Health Insurance Medical Service/ Medizinischen Dienstes der Krankenversicherungen (MDK).

The MDK expert opinion will in turn be based on the "Assessment Guide of Sex Re-Assigning Treatment in Cases of Transsexualtity"/ "Begutachtungsanleitung Geschlechtsangleichende Ma▀nahmen bei Transsexualität" that the National Association of Statutory Health Insurance Funds' Medical Service/ Medizinischer Dienst des Spitzenverbandes Bund der Krankenkassen e.V. (MDS) has first published in 2009. The Begutachtungsanleitung has been aggravating the access to medical treatmens beyond the grade of difficulty that trans*persons and caregivers had already have to face before.

We are not aware of a translation of the Begutachtungsanleitung. We would still like to draw your attention to it. It is worth while to study it carefully, because the MDK expert will certainly do so, too. The Begutachtungsanleitung sets requirements for the order of various medical treatments and associated waiting periods. It covers both with ostensible expert knowledge that makes trans*persons' and caregivers' hair stand on end. Partly or entirely wrong understanding of the Begutachtungsanleitung by health insurance staff complete the list that often leads to unjustified disapproval of cost coverage.

The MDS links the Begutachtungsanleitung and its attachments on its Richtlinien/Grundlagen der MDK-Begutachtung site.



Hair removal at the cosmeticians

Statutory health insurance funds/ gesetzliche Krankenversicherungen (GKV) consider electrical epilation the preferred method for (beard) hair removal. The method is offered by very few physicians after all; in Hamburg, for example, there is none at all. Still the GKV generally covers medical treatment done by physicians only. The burden from this dilemma has traditionally been laid on the affected trans*women's backs.

Even the Begutachtungsanleitung (see above) acknowledges that physicians do not offer the electrical epilation in the framework of the statutory health insurance accredited service to the necessary extent. Despite this acknowledgement, public health insurances have so far not been refraining from disapproving coverage of electrical epilation at cosmeticians in a seemingly random manner. There is a history of public health insurance companies approving or disapproving such coverage from case to case without any comprehensible rationale. Too many trans*women have been facing contradition, lame excuse, delay, denial of the shortage of physicist offering electrical epilation, unreasonable demand to consult the next available physicians located 100 km away, disapproval with general phrases rather than reasons so far.

There was an interesting case against a statutory health insurance company at the State Social Court/ Landessozialgericht of North-Rhine Westfalia. It has to be noted that the court had to reject the case as justified in the verdict dated May 8th, 2014 (in German). Nevertheless, the court has included a very favourable rationale why it the court cannot understand why staturory health insurances should not have to cover the cost of electrical epilation at the cosmeticians given the proven undersupply of the treatment by accredited physicians.

The court's remarks will hopefully close the major access point to disapprovals of coverage, as these remarks lead to way for a potential future decision in a similar case. Some of us have successfully obtained coverage after having cited the verdict in their objection against the initial disapproval of coverage.

However, you have to file a quote prior to the treatment. The court's remarks may not leave much margin to the public health insurance company to disapprove the coverage, but it does not have to accept excessive fees.



Standards of Care (SoC 7)
(Counterpart to the Begutachtungsanleitung)

Full title: Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7
Publisher: World Professional Association for Transgender Health (WPATH), 2011
Source: www.wpath.org --> Publications

The overall goal of the SOC is to provide clinical guidance for health professionals to assist transgender, and gender nonconforming people with safe and effective pathways to achieving lasting personal comfort with their gendered selves, in order to maximize their overall health, psychological well-being, and self-fulfillment.

The SOC 7 makes a significant turn away from former SOC versions. Changes in version 7 relate to significant cultural changes, progress in clinical knowledge and understanding of many questions of the health care that transsexual, transgender and gender nonconforming people may face beyond hormone therapy and surgery.

A key message of the SOC 7 is that (QUOTE) being transsexual, transgender, or gender nonconforming is a matter of diversity, not pathology. (UNQUOTE) WPATH has released a declaration in favour of the worldwide de-pathologization of gender nonconformity in 2010. The declaration considers that expressing gender characteristics and identities that deviate from the sex assigned at birth in a stereotype manner is a common human phenomenon of cultural diversity.

SOC 7 differs fundamentally from outdated former versions that the MDS has used at the time the Begutachtungsanleitung was established.