The preliminary relief judge in Amersfoort ruled this during a procedure that the 21-year-old Lise instituted. The woman has been in treatment at the VUmc since 2016 because of her transsexuality. She has had multiple sex reassignment surgeries. The final piece would be the facial surgery, in which she is stripped of masculine features by breaking open the jaw and reshaping bone structures.
According to Lise and her doctors from the VUmc, she is struggling with a so-called passability problem; she is not recognized as a woman and therefore gets annoying reactions in the street.
Zilveren Kruis disagreed. It was rejected one day after her application, because the insurer ruled on the basis of photos that there were no male facial features.
The woman’s doctors had insisted on the operation, because there would indeed be masculine traits. According to the judge, Zilveren Kruis did not take that judgment of the doctors as a starting point sufficiently. That should have been. If the insurer’s medical advisers disagree with the treating physician’s judgment, they should have contacted that physician, rather than rejecting the request immediately.
The attending physician and three other doctors of the VUmc affiliated with the gender team filled in a list with external characteristics to substantiate Lise’s application. This list has been developed by the National Health Care Institute in order to determine as objectively as possible whether there is a passability problem. According to the judge, Zilveren Kruis has insufficiently motivated why those guidelines were not followed.
The decision does not automatically mean that Zilveren Kruis has to pay for Lise’s surgery. There is still a chance that the decision will have a negative effect, but the insurer must provide good reasons for that decision.
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