Insurance coverage for gynecomastia surgery

Insurance coverage for gynecomastia surgery is one of the commonly asked and searched questions on this site. There is no definite answer for this because, different companies have different ways on looking at insurance coverage for gynecomastia surgery claims. The very short answer is yes and no or to be more precise, “it depends”. This is something that you have to be careful about because if you take it for granted that surgery for gynecomastia is covered by your insurance coverage, then you could be disappointed.

Why you should look at gynecomastia surgery and insurance coverage for gynecomastia surgery ?

There are a few treatment options to get rid of gynecomastia and surgery is one among them. What makes surgery unique and worthwhile is that it is unique and personalized. A surgeon specializing in gynecomastia will talk to you, will take your preferences into consideration and plan the surgery. Your gynecomastia surgeon will also perform the surgery in a way that it complements your physiology and body contours. If you have tried one of the breast reduction pills for men and the success rate is not what you expected, then gynecomastia surgery would be your only remaining option. You will wake up from anesthesia as a completely different man with a completely different body self-image.

Advantages

  • Gynecomastia surgery is a 100% guaranteed option to get rid of gynecomastia

  • It is the only treatment option that is personalized from start to finish. The surgery is done based on your personal preferences

  • There is no guesswork involved and you will be counseled by the surgeon before about how your chest will look like after surgery

  • The difference is LIFE CHANGING!, not to mention the turbo boost in your self-confidence

Disadvantages

  • You will have to go under the knife and some people simply does not want it

  • Post-surgery period is painful as the surgical opening is healed and there will also be an uneasiness around your nipples and chest area in general

  • You are looking at spending not less than $7000 and this is also a deal breaker for many individuals who wants to get rid of gynecomastia. This makes it all the more important to see if you can get insurance coverage for gynecomastia surgery.

An image in a post about insurance coverage for gynecomastia surgery

Gynecomastia Surgery Cost

If you are interested to get rid of gynecomastia through surgery, under normal medical circumstances, you are looking at paying between USD 6000 – 8500 depending upon the facility where the surgery is carried as well as the experience and profile of the surgeon.

Break down of gynecomastia surgery cost

Procedure / Service Approximate cost
Surgeon Fee $ 4000 – $ 4500
Anesthesia $ 1500 – $ 2000
Lab Tests $ 500 – $ 1000
Post-surgery Compression Shirts / Vest $ 100- $ 500

Check your company policy on insurance coverage for gynecomastia surgery

The first step is to go through your insurance coverage guidelines and to know first-hand what they say about insurance coverage for gynecomastia surgery because different companies have different policy guidelines when it comes to insurance coverage for gynecomastia surgery. You will get a clear idea as to in what all circumstances are exceptions allowed. The next step is to talk with your doctor who will be the best help that you can get when corresponding with the insurance company. Doctors are more than happy to help you in your efforts to get rid of gynecomastia and in fact, it is the official position of the American Society of Plastic Surgeons that gynecomastia from grade level 2 must be covered by insurance. Often times, the doctors can start a series of correspondence with the insurance company advocating for you and backing their claims with lab results and other tests that would help you get insurance coverage for gynecomastia surgery. Below are the main requirements laid out by majority of insurance companies for getting insurance coverage for gynecomastia surgery.

The information I am listing here about insurance coverage for gynecomastia surgery are based on collective research on prevailing policy on insurance coverage for gynecomastia surgery but, different companies might have slightly different wordings and terminologies. The general consensus among all the insurance companies on insurance coverage for gynecomastia surgery are more or less the same. To be eligible to get insurance coverage for gynecomastia surgery, you need to fulfill ALL of the following conditions.

Diagnosis Required
A well-defined physical and/or physiological abnormality resulting in a medical condition that has required or requires treatment Yes
The physical and/or physiological abnormality has resulted in a functional deficit Yes
The functional deficit is recurrent or persistent in nature Yes

Now there are some pretty complicated corporate and medical jargons thrown in there to basically nip any attempts in the bud to claim insurance coverage for gynecomastia surgery. I am going to try to decode this into plain language and it simply says that there should be a serious medical condition that stops your body from doing its natural functions. This medical condition should warrant emergency response so that it will not become life threatening in the future. On top of this you will have to present them numerous tests and reports from your doctor. This is not to discourage you but, I just wanted to give you a picture of what you will be looking at in case, you decide to approach your company asking to cover your gynecomastia surgery.

When is insurance coverage for gynecomastia surgery provided

For some individuals, gynecomastia poses serious health concerns. A classic example is a tumour that is developing along with the breast issue. For others there is the possibility of extreme pain and in such cases, surgery become a necessity rather than a nicety. So the bottom line is that, there must be ample evidence that the growth poses a serious challenge to an individual’s health as of now or in the foreseeable future. Before granting coverage for gynecomastia surgery, the insurance company would want the doctor to do extensive medical check-ups and laboratory tests to make sure that it is in fact a necessity.

When is insurance coverage for gynecomastia surgery NOT provided

For the majority of men who has gynecomastia in one of the four grades, the effects are mostly psychological. Gynecomastia is a crushing blow to one’s esteem and this is something that I have personally experienced. From an insurance company’s point of view, these are cosmetic procedures and not something that is done to stop or retard a life threatening condition. So if gynecomastia is not associated with a serious and life threatening medical situation like extreme pain or a cancerous tumour, the chances of getting approval for insurance coverage for gynecomastia surgery are low. In almost 99% of the cases when the rationale for surgery is mentioned as something for psychological benefits, coverage is not given in the first request. You or your gynecomastia surgeon will have to correspond with tests or lab results or scans that proves that there is a potential risk or you are experiencing a lot of pain to warrant insurance coverage for gynecomastia surgery.

List Of Medical Insurance Providers & Terms For Covering Gynecomastia Surgery

No Insurance Provider Name Terms For Coverage
1 AARP  Info not available
2 Aetna Coverage terms available
3 American Family Insurance Info not available
4 American National Insurance Company Info not available
5 Amerigroup Info not available
6 Anthem Blue Cross and Blue Shield Coverage terms available
7 Assurant  Info not available
8 Blue Cross and Blue Shield Association  Coverage terms available
9 Cambia Health Solutions  Info not available
10 Centene Corporation   Info not available
11 CIGNA  Coverage terms available
12 Coventry Health Care  Coverage terms available
13 Emblem Health  Coverage terms available
14 Fortis  Cannot even find their website
15 Golden Rule Insurance Company Coverage terms available
16 Group Health Cooperative  Info not available
17 GHI Insurance Coverage terms available
18 Health Net Coverage terms available
19 Health Partners  Coverage terms available
20 Health Spring  A CIGNA Subsidiary
21 Highmark Coverage terms available
22 Humana  Coverage terms available
23 Independence Blue Cross  Coverage terms available
24 Kaiser Permanente  Info not available
25 LifeWise Health Plan of Oregon  Coverage terms available
26 Medica  Coverage terms available
27 Medical Mutual of Ohio  Coverage terms available
28 Molina Healthcare Coverage terms available
29 Premera Blue Cross  Coverage terms available
30 United Health Care Coverage terms available
31 Wellcare Health Plans  Coverage terms available
32 Wellpoint  Info not available

Why insurance companies seldom cover gynecomastia surgery ?

We have to look from the insurance company’s perspective to understand why they have such a militant attitude in rejecting insurance coverage for gynecomastia. The main concern for them is that once they start offering coverage for gynecomastia surgery, it will open an equivalent of a Pandora’s box where everyone would come with a claim for a surgery that they believe would enhance their psychological well-being. My educated guess is that this is the main reason why almost all insurance companies nip it in the bud itself. No insurance company will approve for insurance coverage for gynecomastia the first time unless there is very strong evidence that a life-threatening condition is associated with the breast tissue development. In fact, not less than 1 in 13 claims are denied initially. You can appeal the decision and there is the likelihood of getting a favorable response after corresponding with your insurance company with the help of your surgeon.

If gynecomastia insurance coverage is denied, what next ?

If you have been denied despite multiple reasonable attempts with your insurance provider, you can go for litigation against your insurance provider but keep in mind that you are going to fight against billion dollar corporations with an armada of lawyers at their disposal. It simply does not make sense because you will from your end pay multiple times the cost of gynecomastia surgery as lawyers fee. If you are denied gynecomastia surgery insurance coverage, I strongly suggest you look at the breast reduction pills as an alternate option. Your other option would be to pay for the surgery out of your pocket or to finance it. If you are interested to know more about gynecomastia surgery, companies that offer financing and payment options, download this FREE report.