Insurance?

[texastoast88]

I was discussing with my dad how I intend to pay for the surgery, and I know I have the money to pay for it in full. He brought up insurance and that they may be bale to help. Currently, I'm on my moms insurance which has a $3000 deductible, and I pay 10% of however much it costs after that. I have read on here about insurance possibly helping out but I'm not too sure that with my minor case, they will. It doesn't cause me any physical pain at all, but emotionally, it has basically wreaked havoc. I'm majorally self conscious, especially around women. I have had periods of depression when facing this. I worked out for awhile and got pretty strong but I could never get the puffiness gone completely, thus confirming my fear that it was gynecomastia. Basically, I'm posting to ask and hopefully have answered 2 questions:

1) Is it possible for insurance to cover a minor case of gynecomastia, given the emotional scars it has left?
2) Is there anything I can say to help the insurers or doctors (if that's who I need to talk to) to understand the impact and the fact that paying for this out of pocket will somewhat cripple me financially for awhile?

If they don't cover it, it's whatever. I'll pay for it 100% out of pocket. But if I can save money, I will.

[alphajc]

From what I have heard...for insurance to cover gyne reduction procedures...1) It needs to be severe and largely not due to being overweight  2)  Cause physical pain...back pain, tenderness, etc .

Having emotional pain helps the cause too, but I think a lot of people with gynecomastia have this and is a low bar to cross.  You sound like a fit person with some puffy nipples based on your description.  I wouldn't pursue the insurance route, especially with the 3k deductible.  Also even if insurance did cover it, they would likely refer you to a surgeon in their own network (possibly a general surgeon, vs plastic surgeon) and that wouldn't be good.

Money shouldn't be the #1 issue when it comes to GRS.  Finding the best surgeon and having the will to go through with it is it.  Money tends to take care of itself...especially if you have credit.

[texastoast88]

That's what I assumed. Unfortunately, many with gynecomastia do have emotional issues. I'll attempt once more to communicate this to my parents. I have a little fat on myself, mainly because once I graduated college, I lazed off a bit with working out (bmi hovering @22). Currently, I'm lifting weights again daily as well as running 3+ miles, the goal is to get is as good of shape as possible (lower my bmi) so my results are worth the risk. Anyway, I appreciate the response, I certainly do not want to do the insurance route if I won't be able to see a plastic surgeon with sufficient experience in this type of surgery.

[Paa_Paw]

Insurance coverage varies greatly. Many policies specifically exclude any surgery that is cosmetic. That exclusion would mean that except for the rare cases where a man actually had some kind of breast pathology the surgery would not be covered.

There are a few policies that do cover the surgery, and conditions under which coverage exist are not standardized.

The best coverage will usually exist in policies which are more inclusive and these are the most expensive policies. Since most of us have Medical Insurance policies selected upon the basis of cost, It naturally follows that most of us have no coverage for this kind of surgery.

Another thing to consider is the possibility that the Insurance company may insist upon services being provided by their Surgeons. Their surgeon may not have specific experience with this type of surgery which would leave their qualifications in serious doubt.

Carefully read your policy and see where you stand with respect to Cosmetic Surgery. It could be possible that you can get the surgery performed by a well qualified surgeon. If not, then you should expect to pay the price and have it done right.

My Grandfather (a carpenter) used to say: "If we can't take the time to do a job right, when shall we find time to do it over?" You should rephrase that to apply to your present situation and do it right the first time. Surgical revisions are expensive and fraught with problems.

[TheCorrectedOne]

Hi. if you can wait for surgery a few weeks more to save some money a Psychiatrist may help you convince the insurance. you need to tell him the part with the girls. not being able to talk to girls is a big disability. (i couldn't even talk to guys with out wearing a XXL sweatshirt. that's how i got them to pay for it. in my case it was a 3. degree gynecomastia though.

[Paa_Paw]

A good point well stated.

It may sound like a bit of a stretch, but it is true. If a psychological problem is caused by the Gynecomastia, Surgery to remove the Gynecomastia will cure the psychological problem. This has been used successfully to gain coverage for surgery even when the initial request was denied.

Again though, individual policies differ.

[texastoast88]

I may try the psychiatrist route to see if that pans out. My dad is convinced we can get insurance to cover it and he understands the importance too, that this needs to be done by a board certified plastic surgeon. He told me they may want you to go to a surgeon in their network but you can still choose, they just won't cover as much. Currently, I am on my Mom's insurance plan and she has called them to see if it's covered. They had no idea what Gynecomastia was and said they'd need to do some research and call her back. I'll let you guys know what happens with the insurance company in the weeks to come. Crossing my fingers.