Gynecomastia and Insurance

[nothingworse]

I can tell anyone who wonders why insurance companies don't cover gynecomastia procedures. It may effect us the person. But, insurance companies love to play doctor. That means that they think that everyone can live with it and they are very knowledgeable and think it is not an important issue. The thing is maybe if more people took the time to push the issue with insurance companies some day they could change there ways. Some insurance companies don't even cover breast augmentation for women. Not getting them reduced can cause major back problems and slouching for women. Men with larger breasts probably also may experience this problem. Years ago insurance companies covered many procedures not covered today by insurance. And by years ago I mean 7-12 years ago. Thats before the time they started to play doctor. If more insurance companies took the time to realize gynecomastia like womens breast reduction is a serious issue maybe it would be easier to get the insurance to cover it and get this emotional mess over for many of us. As the economy gets worse out there insurance will continue to get worse. High premiums for nothing. The thousands we spend for neglect is beginning to get insane. I just wish more insurance companies would get the picture that if people pay for there insurance and have a problem even if they don't like the problem to pay for it. The companies get many discounts on these procedures and on half of those cases lets say they pay out $5000 supposedely they are most likely paying half. And yes you can get a discount on surgery from any surgeon. Some may deny that and say that this is the price range. But, if it is for something they consider simple what do they have to lose. They have higher costs but, do a lot of surgeries and are always ahead of the game. Just like my parents deal in antiques they may pay $500 for an item and sell it for $600 but, it is still somewhat of a profit. So, if insurance doesn't cover my surgery within the next month my parents said they can get the surgery done for me for half. Which they can. They bought a new neon for $7000 off the sticker because they fight to get every last penny off. So, If we have to pay for the surgery were looking at about $2000-2500. So, if anyone on this board has to pay for there surgery try to negotiate first. You always can get something off. Maybe by negotiating hard you can get 25% off plus of your surgery and that is a huge savings and you will not have to save as long. So all of you please consider this option of negotiating with a skilled surgeon first. It may get you your surgery faster and that extra money saved can go to something else.

[JTZ]

Some people on here have had health insurance that completely or partially covered the cost of their gyno surgery.

[nothingworse]

My parents have Aetna Premium Insurance Health Plan and it still won't cover it. $6000 a year they pay for insurance. My father has HMO also. Neither of those cover a penny of it. They are the best insurances in the U.S. Maybe in Canda were insurance and medical stuff is done right but, I don't know about the U.S. Sometimes I wish our health and medicine was like Canadas. The canadians know whats going on in the health world. But we have the biggest retard of a president who doesn't even know how to handle Social Security and has created the largest budget deficit in history. Who is more concerned about war then our own problems in our country. His first four years severely damaged us and the next four years could be our doom. D*** him. Well, I hear back from Aetna in 3 weeks regarding my case. I will let you guys know. But, even though I have a painful and uncomftorable case I know it is going to be no. Not to be negative. So, my mom wants to personably call them and ask them what they are going to suggest. What else can they suggest. Surgery is my answer even backed by my doctor and the specialist I saw. So, what are they going to say can't help you even though it will hinder the rest of your life. With this appeal they will be stuck in a rut and will have to pay for this surgery. This is going to be a waste of time but, in the end it will all be worth it.

[j1ggastyle]

I'm in the same fight with Aetna...Has anyone been successful with them??

[nothingworse]

Sorry to hear that man. I hope the fight ends in about 3 weeks but, somehow I know it won't. If you haven't already tried this you should do this. If your parents are your gaurdian or you are an adult here is what you should do. First call Aetna and get ahold of the person handling the claims or whoever is handling this and ask them what they suggest? They can't tell you no, because you pay insurance and it is affecting you. They can't suggest anything else but surgery for a positive solution. The worst they could do is tell you to try some medicine for 30 days and when that doesn't work because it won't they are at there last option and will be stuck in a corner because there would be no other comeback. After realizing how stupid they were they most likely will approve your case but, they may still reject you. But, when you think about it how can they you pay for services and there is a correct solution. So why I ask would they hold that solution from you as a good costumer? It would be worth a try. Or maybe they could pay half and you could negotiate a price with a surgeon and pay very little out of your pocket. Save a little back up money just in case. It is so weird why you have to fight for this. Good luck to you and I will let you know what goes down in about 2-3 weeks from now. They can't deny me because mine is painful and uncomftorable only the puffy nipple part of my procedure would be cosmetic so they should cover it. You know they are the expensivest of insurances in the U.S. and they can't cover some of the cheapest PS's. With that extra money Aetna has been banking because of denials they must be one profitable business. All I know is my parents have had them for about 22 years and only in the past 2-4 years have they been a real pain. One can only guess this because corporate greed and more unemployment is happening. I am guessing they are billionaires and make big deals out of small claim cases like this. I can understand if someone tries to get them to cover $50,000 worth of cosmetic surgery for their whole body for the sake of them looking like a famous celeb or something stupid like that. But, getting this is for emotional, phyiscal, and psychological help. It is for good and not waste. If they spent more time concentrating on the wastes than the goods maybe we wouldn't have such a problem.

[Spleen]

The only cases where I've heard of an insurance company paying for gynecomastia surgery were either people with illnesses that caused the problem (like testicular cancer, hypogonadism, etc.) or the rare, rare case where someone was persistent, smart and luccky enough to find an agent or underwriter to pay.

I might be in the minority here, but I agree that insurance companies ought not pay for ordinary gynecomastia correction.  It's elective cosmetic surgery, plain & simple.  Should insurance companies pay for boob jobs, nose jobs or to correct ears that stick out?  I'm sure there are people with each of these issues that complain about the "emotional mess" that their "affliction" brings them.  Even though I spent a lot of money on my own surgery, I prefer that to seeing premiums rise even higher for everyone if elective procedures were blanket covered.

[Paa_Paw]

Thank you Spleen for seeing the issue so clearly.

Our condition is not rare. Estimates are that 2/3 of all adult males have Gynecomastia to some degree.  

If you can demonstrate that there is a medical neccessity,  Then you should have the surgery and the Insurance should cover it.  Lacking a medical neccessity, there is no justification for using medical insurance to perform cosmetic surgery.  

Education is much more important,  and while many young men are no where near ready to accept this; the condition of gynecomastia is so common that many people believe it to be normal.

It runs in my family, it is normal for me!