Insurance Denial

[ccooley]

Hi Everyone...My son has severe Gynecomastia and was denied coverage for insurance under our United Healthcare plan saying it was elective - as it doesn't cause him any pain. If you know the ridicule he's recieved, you'de know how wrong that is...But NOW, after promising us a right to two appeals with their boards, that they promised would be disposed of within one month (we got the letter acknowleging our appeal 6 months ago), they simply have not responded whatsoever. We havd sent 3 letters (the last on registered) and gotten NO response at all.
Is this a ploy? Does anyone have any insight into these appeal boards and their methods?

Thanks in advance,

Chris Cooley
(on behalf of my son)

[littlebear]

You don't say how old your son is, Chris, but has he had the surgery yet?  If not, I would do it anyway.  Take out a loan if you have to.  You don't want to wait too long and have the problem cause him any psychological damage.  

Has your surgeon or your family physician sent letters to the insurance company?  Both of mine did, and I really think it made a difference in the insurance company's decision.

If the issue is still the insurance company's lack of response, maybe you should contact your state's department of insurance and file a complaint.

[Guyver1]

Does your son have Gyno on both sides or just one side? If he only has it on one side then it isn't considered to be plastic surgery and your company should cover the surgery. Just something to add, my doctor told me that Bi-lateral gyno can sometimes mean a tumor of the pituitary gland, talk to your son's doctor and have him check and see if he can find a way to get your insurance company to cover it.

[have5kids]

  Please don't give up.  I'm from Canada where we have  government funded health care, but we we're also told that this surgery would be considered cosmetic.  With the help of my member of parliment and the endocrinoligist, I wrote to the government and they have now agreed to pay for my son's surgery.  Be persistent, it might take just hitting the right person who will understand the saituation.  I know that it shouldn't take a rocket scientist to figure out how emotionally painful this is for a boy.  Good luck

[Arjun]

There are a few things you should get checked out which can make a good case to your insurance company. Somebody mentioned the pituatary gland. Now that is a gland in the brain and it releases a chemcial called adinoma. Adinoma is secreted throughout the body and encourages breast development as well as estrogen. If adinoma is being secreted then you may want to talk to your doctor about reversal pills. However there are some cases where the pills do not work as anti-estrogen pills. In these cases the sitaution no longer becomes cosmetic. We clearly have a sign on irregular functioning of the body. The only way to correct it is surgery. Usually adinoma stops being produced in the body for males but there still is a significant lefty over amount which can be removed by surgery. Adinoma causes what we call excess fat. It has other things which it does but this is just an example. Analyze your sons situation. Does he ever get severe head aches? blurry or watery eyes? shortness of breath? These are all somehow linked to the brain which can be linked to the pituatary gland. Ask your doctor for further explanation and if the insurance company asks for pain in exchange for the surgery. Any of the above can be linked. What I dont understand is the medical companies are completly stupid because we all know that sometimes pyhscological damage is not really reverible where as physical can be. So you tell me which is more dangerous? I really think the people who make these decisions should get a slap in the face. Well I hope I may have helped. If you need more help please dont hesitate to reply. Thank you

Arjun

[Grandpa Bambu]

Please don't give up.  I'm from Canada where we have  government funded health care, but we we're also told that this surgery would be considered cosmetic.  With the help of my member of parliment and the endocrinoligist, I wrote to the government and they have now agreed to pay for my son's surgery.  Be persistent, it might take just hitting the right person who will understand the saituation.  I know that it shouldn't take a rocket scientist to figure out how emotionally painful this is for a boy.  Good luck

It's strange how insurance companies acknowledge physical pain but not emotional pain. Odd that!  

[Paa_Paw]

If you go to the front page of this site, you will find a story written by by the mother of a boy who had gynecomastia.  It details the battle that they had to go through to get the insurance to cover his surgery.

The long and short of it is that for some young men gynecomastia can cause emotional problems, lack of self worth, social isolation etc.  It may be helpful to get an opinion from a Psychologist to support the need for surgery.

Good luck!

[vaio]

Tell them it hurts. It pintches, stings whatever. Lie about it.

[Paa_Paw]

I respectfully disagree.

The emotional pain that some of these young men endure is real enough and severe enough. That is the story that must be told.

There is no reason or justification for lying unless you wish to ruin your own credibility.