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