Although some transgender people have access to gender reassignment surgery (SRS), an overwhelming majority cannot afford to have one Facial Feminization Surgery (FFS) to be carried out. An SRS initial may be covered by insurance as being 'medically necessary', but FFS is considered purely cosmetic and is therefore not reimbursed. The label “cosmetic” stands in direct contrast to the scientific community's understanding of gender dysphoria as well as professional guidelines for transgender health.
In most cases it is still extremely difficult to get FFS surgery covered by your insurance. We do know of certain cases where people have resisted the decision of their insurance company, and who were subsequently reimbursed after a long legal battle. We try to collect such cases on this page. If you have experienced a similar story, please feel free to share it with us so we can make this page as useful as possible for the trans community.
This information is based on patient experiences. We cannot guarantee that what is written here applies to everyone. We welcome feedback if you have any other relevant information for us or if you have managed to obtain a refund where this was previously considered impossible.
In principle, an FFS is not reimbursed by health insurance. Only wound care and medicines are reimbursed.
Whether the insurer covers (partially) the costs depends on the type of treatment, but also on the company's policy. Some treatments are considered purely cosmetic and are not reimbursed. Other procedures may be seen as medically necessary. Ask the insurance company in advance what they normally reimburse and what they do not reimburse. This prevents disappointment.
If the insurer agrees to the S2 application, the patient must submit the form to the clinic. The practitioner decides whether the costs are declared directly to the insurer or whether the patient receives the invoice and must pay in advance. In the latter case, the patient can forward the bill to the insurer and request a refund. This must include a medical report from the treating physician.
You can submit an S2 application to CZ, one of the largest insurance companies in the Netherlands, if the treatment cannot be carried out in the Netherlands or cannot be carried out on time. Other health insurance funds, such as Interpolis and Zilveren Kruis, only indicate that the treatment may not be urgent. Although an S2 claim can be submitted for any type of treatment, each claim is assessed individually and therefore there are no guarantees that a refund will be made.
You will always be asked for a treatment plan and a cost estimate, which we can provide to you. The doctor at the clinic where the treatment will take place can indicate how urgent the procedure is. A referral letter from a Dutch doctor reinforces the request. It does not matter whether the desired operation takes place in a regular hospital or in a private clinic.
An example of a response from an insurance company (Zilveren Kruis) to an S2 request can be found here: Insurance letter Zilveren Kruis
If you need help from a lawyer (in the Netherlands) to help you during negotiations with your insurance company, we recommend Ms. Desiree Maes, also known as “The Pink Lawyer”.
Trompenburg Lawyers
12 Schoter road
2021 HM Haarlem
T: 023- 525 59 59
maes@trompenburg advocaten.nl
www.trompenburg advocaten.nl