Health insurers to automatically reimburse more breast reconstruction surgeries

Health insurers in the Netherlands will adjust their authorization policy for “complete tertiary breast reconstruction” surgeries after breast cancer so that these are automatically approved, Zorverzekeraars Nederland (ZN) announced. The Dutch Association for Plastic Surgeons (NVPC) stressed that this does not apply to all follow-up surgeries but is a “huge step in the right direction.”

The trade association made this announcement one day after reports that health insurers were still asking women to submit photos of their breasts when they apply for follow-up surgery after breast reconstruction. These photos weren’t always handled carefully and women often had to complain before their surgery got reimbursed. The fact that women have to apply for pre-approval with their health insurer at all is controversial - health insurers don’t require such an application before reimbursing follow-up surgeries for reconstructions in any other type of cancer.

According to ZN, the adjustment means that, with immediate effect, women will no longer have to share photos with their insurer when applying for pre-approval for a follow-up breast reconstruction surgery. “If necessary, photos will be required in the plastic surgeon’s medical file,” the association said.

“For administrative purposes, the application (without photos) must still be submitted in 2024 but will be approved by default. From 2024, the authorization policy for complete tertiary breast reconstruction after breast cancer will be abolished,” the association said. It stressed that this applies to contracted care that meets the health insurer’s policy conditions.

ZN director Petra Holst said that she regrets that the pre-approval process led to “undesirable situations for some women” and thereby damaged their trust. “I’m glad this has been resolved,” she said.

Edin Hajder of the NVPC told NOS that this adjustment is a “huge step in the right direction” for health insurers. “We are happy for women that they are not in unnecessary uncertainty. And that they no longer have to send nude photos. The assessment is rightly back in the hands of the plastic surgeon.”

He did stress that the adjustment does not mean that all follow-up surgeries will be standardly reimbursed. “This concerns reconstructions that have to be done from scratch. It is not about smaller interventions, like repairing dents.” It also doesn’t cover women who have already submitted applications for follow-up surgery or those who have previously been rejected.

A spokesperson for ZN told the broadcaster that health insurers will discuss smaller surgeries with the plastic surgeons in the “short term.”