Health insurers are still asking breast cancer patients to send photos of their breasts to decide if they will cover reconstructive surgery, a year after the health ministry banned the practice.

New rules that came into force at the start of 2023 require insurers to use medical photographs taken by a plastic surgeon in a clinical setting, rather than contacting the patient directly.

Reconstruction after other forms of cancer is covered by health insurers, but breast cancer patients who ask for further treatment because of pain or misalignment are subjected to extra checks, including requests for photographs.

Legal experts earlier criticised the rules for reconstruction after breast cancer as “discrimination” and “unjustifiable”. Around 5,500 women every year opt for reconstructive surgery with silicone or grafted tissue after a mastectomy.

The reconstruction itself is covered as standard, but in many cases insurers only agree to pay for further operations after the patient files a complaint, NOS reported.

Patient Ellen Karstens said she had to fight tooth and nail to secure cover from her insurer UMC, part of VGZ, filing two complaints.

“I managed to force the issue, but a lot of women with cancer are worn out and don’t have the energy,” she said. “Insurers have no idea what this does to us.”

Privacy concerns

Health minister Ernst Kuipers changed the regulations three years ago to stop insurers asking patients to supply photographs, partly because of concerns about the privacy implications. Photographs were requested by insecure emails and were sometimes shared between several departments or went missing.

VGZ said it only requested photographs in response to a complaint and had a preference for photos taken in hospital. It said it had issued new instructions to its staff and would be carrying out extra checks.

The health insurers’ association Zorgverzekeraars Nederland said: “We are sorry to hear that women end up in this situation, but health insurers cannot automatically approve all requests from care providers.”

Corrette Ploem, professor of health law at the UMC Amsterdam, said: “Every time this happens is once too many. It gives off a strong sense of ‘if we, the insurer, stand our ground, the insured party might not challenge a refusal.

“Plastic surgeons should decide if operations are necessary. It’s not luxury healthcare, it’s essential.”