Dutch insurers demand nudes from breast cancer patients despite ban
No photos? No, second operation
Updated Dutch health insurers are reportedly forcing breast cancer patients to submit photos of their breasts prior to reconstructive surgery despite a government ban on precisely that.
That sounds pretty bad but it gets worse: These insurers keep losing their copies of these highly intimate pictures, one way or another.
Some insurers don't use secure websites and/or other means of electronic communications to transfer these very sensitive photos, according to the Netherlands public broadcaster NOS. Patients reported that their insurance companies have lost their photos, and denied their requests for reconstructive surgeries following a breast-cancer diagnosis.
In addition to being intrusive and humiliating — and, we're told, not a requirement for any other types of cancer-related surgeries — cancer patients' photos have been stolen by ransomware crews in the past, and then used to extort victims. Some of these images ended up published online in data dumps, and now patients are suing the healthcare provider for allowing the "preventable" and "seriously damaging" leak.
While the initial reconstruction is reimbursed by health insurers, if the patients require a follow-up surgery insurers generally require photos to determine whether they will cover it.
After a media outcry about the situation in 2021 the Dutch Health Minister required that these photos be taken in a hospital, with the rules coming into effect on January 1, 2023. Some hospitals have since refused to do this, citing the sensitive nature of the images and potential privacy nightmares.
Meanwhile, health insurance orgs aren't necessarily following this rule, and are still asking patients directly for photos. One patient interviewed by NOS and insured by CZ was asked to send the nudes via email before the insurer would reimburse a second procedure after a botched first operation.
So she did, "with great reluctance," and was later told by CZ that the photos had been lost.
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When asked about the patients' claims, a CZ spokesperson told The Register: "Dutch health insurer CZ does not ask breast cancer patients to submit photos."
The insurer, however, told NOS that it does request photos from the patients "if the plastic surgeon doesn't want to send photos," and described the lost pic as "very annoying."
Other patients, including those insured by health corporation VGZ, also reported being asked to to submit images of their breasts and then losing them. One reported being told to send the images via unsecured email and an employee telling her they had been passed "from one counter to another."
That insurance group told NOS that "only in the event of a complaint can policyholders be asked for photos."
The Register could not reach VGZ for comment, and the Health Minister did not immediately respond to our questions including if the agency planned to take action. ®
Updated to add on February 13
The trade body for Dutch health insurers, Zorgverzekeraars Nederland (Health Insurers Netherlands), has now changed its policy, and patients will no longer have to submit photos to insurers to get approval for follow-up breast cancer operations. Instead any photographic evidence will stay with doctors.
In addition, any requests made this year will be "approved by default" without photos, and in 2025 the existing authorization process for breast reconstruction after cancer treatment will be abolished.
"We regret that applications for tertiary breast reconstruction have led to undesirable situations for some women and have therefore damaged confidence," said Petra van Holst, director of Health Insurers Netherlands.
"I'm glad this has been resolved. If women have any questions about their specific situation, we ask these women to contact their health insurer."