Health Insurance & Gyne

[ru_486]

I was wondering if anyone has had success getting an HMO to pay for their surgery. I have a very good policy through blue cross/blue shield. and was wondering if anyone had dealt with them directly or not. Any advice on where to start and/or what to say is greatly appreciated. I really need this surgery but simply do not have the funds. I had an appointment w/ Dr. Bermant around this time last year but had to cancel for that reason.

Also, how long post-op would it be b4 I could go to the beach? (I know dumb question but I'd like to know id I could have the surgery b4 my wedding)

Thanks.

[ru_486]

Anyone.....

[Paa_Paw]

Most insurance policies specifically exclude surgery performed for purely cosmetic reasons.

Surgery can be covered in many cases if there is some pathology involved. Usually, there is not physical pathology in the usual sense so this does not often apply. But there is another out-----

If you suffer from social withdrawal, poor self image, or any of the multitude of emotional issues which often plague those of us with Gynecomastia; You might qualify for surgery as a treatment for the Psychological issues.

This is sometimes a bit of a stretch, and rather iffy at best; but your best ally could very well be a Psychologist. Your Insurance should cover the referral to a Psychologist if it came from your primary care Doctor.  A letter from the Psychologist may help you to get the Insurance to cover (at least partially) the cost of surgery.

Good Luck!

[gynebegone2]

Essentially you need to find a way to document your condition to show that it causes considerable pain, and that in order to remedy that pain you must have the operation.  For instance if you see a psychologist and they are able to determine and document that your condition is causing you irreparable harm psychologically and recommends steps to eliminate your gynecomastia.  Then you need to find a doctor that will attest that the only way to improve your condition is by gynecomastia correction.

Many insurance companies would deny your claim at face value, but if you can convince them that you will not drop the matter, they may allow it.

There was a case in NY where just such an instance occurred, and since it is bad policy, and possibly illegal for insurance companies to write out of their contracts procedures that have sufficient supporting evidence will improve a patients overall health (psychologically and physical), or eliminate pain and suffering. 

If the unfortunate trend of insurance companies continues in the United States, eventually you will have to prove that you will die if you don't receive treatment before you receive insurance support .

That being said..  If your gynecomastia can be shown to have been pre-existing before you received coverage from your insurance provider you may be in for a much larger struggle.  Its not uncommon for someone to be diagnosed with an illness, then purchase insurance and get it treated only for the insurance company to revisit every medical record they can find to prove that you even "might" have had that condition or illness before you purchased insurance.

Good luck.

[Paa_Paw]

Keep in mind that there is a process for reviewing and reconsidering claims which were initially denied.

This means that even initial denial of coverage is not final.

You may have to use the appeal process.