Health insurers still asking women to submit nude photos for breast reconstruction

Dutch health insurers are still asking breast cancer patients to submit photos of their breasts before they approve reconstruction surgeries, even though the Health Minister banned the practice. The photos aren’t always handled carefully, and women end up in an untransparent procedure in which surgery is only reimbursed after they file a complaint, NOS found in its own research.

Many women who had their breasts amputated due to cancer or as a preventive measure due to family cancer history opt for breast reconstruction. The first reconstruction surgery is reimbursed as standard. But follow-up surgery, for example, due to pain or contour deviation, needs pre-approval from the health insurer. That is not a requirement for reconstruction following any other form of cancer.

In most cases, health insurers require photos to assess whether they will reimburse the follow-up surgery. After a media commotion about this in 2021, then-Health Minister Ernst Kupers banned insurers from asking women to submit nude photos. As of 1 January 2023, hospitals must take the photos, and a plastic surgeon will submit them to the health insurer.

But health insurers are not adhering to the rules, NOS found after speaking to several women who had to submit photos themselves.. “I thought: who are you to ask me for photos of my breasts? I really cried when I read that letter,” Martine van de Merwe told the broadcaster, calling the process humiliating. She heard from an employee of her insurer, Zorgzaam, part of VGZ, that the photos she submitted via the website went from one office to another. Another employee advised her to also send the photos by unsecured email.

Christel Frohnert’s insurer - CZ - rejected a follow-up surgery after breast reconstruction even though her surgeon ordered it. CZ told her by phone to send photos of her breasts via secure email if she wanted it to reconsider reimbursement. She did so “with great reluctance.” When she called to follow up, the insurer couldn’t find her photos and asked her to send them again.

Ellen Karsten’s insurer, UMC, part of VGZ, also lost her photos. UMC twice rejected her request for a follow-up surgery and only approved it after she filed a complaint. “I was able to cope with that, but many women with cancer have battled it out and do not have that energy. Insurers have no idea what it does to us. You have had cancer, then you want to complete such a process in order to be able to continue with your life. You don’t do it for fun.”

Health insurer VGZ told NOS that it only asks policyholders for photos in the event of a complaint, and these should preferably be medical photos taken in the hospital. The insurer has re-instructed its employees and will carry out additional checks, it said. VGZ did not want to answer questions about losing photos, passing photos from office to office, or violating the rules by asking women to submit photos themselves.

A spokesperson for CZ told NOS that it is rare for the insurer to ask policyholders to submit photos. “It only happens if the plastic surgeon doesn’t want to send photos.” They also said that losing photos is very rare.

The trade association Healthcare Insurers Netherlands told the broadcaster in writing: “We find it very annoying for women to find themselves in this situation, but health insurers cannot simply reimburse everything that healthcare providers request.”

The Ministry of Health, Welfare, and Sports wouldn’t comment beyond calling the women’s stories moving.