MAJOR COURT VICTORY FOR YOUNG GYNE PATIENT

[BigApple]

fROM The New York Sun, April 4, 2007 Edition

Court Orders Insurance Company To Pay For Teenage Boy's Breast-ReductionBY Special to the Sun
April 4, 2007
URL: http://www.nysun.com/article/51762

An insurance company must pay $5,000 for the surgery of a young man who suffered from an enlarged-breast disorder, a state appellate court in Manhattan ruled yesterday upholding two lower court decisions. The court rejected Group Health Incorporated's claim that the condition, known as gynecomastia, should not be covered because the procedure was "elective cosmetic surgery or treatment." The ruling noted the teenager's "devastating condition with ‘psychosocial' consequences."The company couldn't be immediately reached for comment.

April 4, 2007 Edition > Section: New York >

[notobvious]

nice one

[DFWDJ]

This could be a landmark case my friends.
I do however wonder, how much money was spent to win this $5,000 court case.

The father was acting as legal representation, so it cost them the time off to go to court I suppose.

[Grandpa Bambu]

This could be a landmark case my friends.

Don't be jumping up and down for joy just yet my man. There have been a few cases where young teen boys have battled an insurance co. in court and won. The health insurance industry is not going to pull an instant 180 on Gyne coverage just because a few sufferers have won their appeals in court. It may happen one day, but not any time soon.

The insurance company went on to lose the case in state Supreme Court, and then in the appellate division. The judge called the teen's breast a "deformity" and a "devastating condition with 'psychosocial' consequences."   Sound familiar?

The Full Story

My hat is off to this guy. It takes bawls to expose yourself to your peers to that extent. I'm glad that he won!

Well boyz... you know which insurance co. to go with now....  'Group Health Inc...'   

GB

[BigApple]

Exclusive

Bye-bye breasts, hello wonderful new life

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BY JOSE MARTINEZ
DAILY NEWS STAFF WRITER

Saturday, April 7th 2007, 4:00 AM
       

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Scott Schulman underwent a $5,000 breast-reduction operation.

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At school, Scott Schulman heard taunts comparing him to his friends' mothers.

At the beach, his shirt never came off.

And in shirts-versus-skins basketball games, he was sidelined by breasts far too large for a boy.

"From the time I was 9 years old, I never put myself in a position where someone could see me without a shirt on," Schulman, 20, told the Daily News yesterday. "It was nonstop ridicule."

So when a state appeals court ruled that insurance giant GHI must pay $5,000 for the breast-reduction surgery that Schulman underwent three years ago, he was extremely grateful.

"It's about time that a Joe Schmo can take on a big company and win," Schulman declared, speaking publicly for the first time. "Why can't the little guy win?"

Schulman's 52-year-old father, Steve, a salesman from Oceanside, L.I., represented himself in Small Claims Court and then all the way to the Appellate Division after the insurance giant refused to pay for the surgery.

The procedure, GHI said, was cosmetic and not essential.

But Scott Schulman, now a prelaw student at the State University of New York at Albany, said breast-reduction surgery was vital for him to live a normal life.

"It was a complete 180-degree turn in my life," he said. "I have a girlfriend now and I feel like I'm a whole new person."

For most of his life, the condition that left him with enlarged breasts - known as gynecomastia - was Schulman's biggest hurdle.

"I remember one time, I was at Six Flags in Ohio and we were going on this water ride," he said. "But when I got to the top, and they told me I would have to take my shirt off, I just walked all the way to the bottom."

Worse, he said, were the stinging names he heard from classmates. "They were so bad, I can't even bring myself to say them," he said.

All along, Steve Schulman saw the surgery as a way for his son to escape his personal misery. He just didn't expect his insurance company to fight the bill.

"Whatever it cost, I would have done it," he said.

The prospect of going head-to-head with big-time lawyers didn't faze him either - until the case reached the Appellate Division on Madison Ave.

"I walked in there and it was like walking into the Supreme Court," he said.

The panel of judges ruled that GHI should pay for the operation, and criticized the company for downplaying just how much the condition affected Scott Schulman's state of mind.

Schulman said he hopes his case inspires other boys who are burdened with large breasts.

"I know there are thousands of others just like me," he said. "I want them to know that if they really want help, that they should go for it."

jmartinez@edit.nydailynews.com

[Grandpa Bambu]

"I remember one time, I was at Six Flags in Ohio and we were going on this water ride," he said. "But when I got to the top, and they told me I would have to take my shirt off, I just walked all the way to the bottom."

 

GB

[cody sockeye]

Eff the corporations. They have no soul. STICK IT TO EM AND TAKE EM TO COURT! 

[Paa_Paw]

I will have to agree with Bambu that it would be too early to be overly optimistic about this decision.  Similar cases have been won before without any significant policy change on the part of insurance companies.

What is of most interest, is the fact that the Psychological issues were specifically cited as part of the reasoning for the decision.  Some time ago, I was flamed for suggesting that a psychologist could be an important ally in a case where insurance coverage had been denied. I stand by what I had previously said, and this case illustrates why I do.

In all probability, the Insurance company will cover the Psychological consultation.

Truly, it is a bit of a stretch; using surgery to alleviate a Psychological problem; but it works!

[jofus22]

Great! Now what about the rest of us teenagers with puffy nipples.

[GrandMstrBud]

What do we have to loose by fighting the insurance company when they refuse to pay for this procedure if we have it done? I don't think we have anything to loose and everything to gain. If I ever get enough money to get it done I will try might hardest to have my insurance pay for some of it. I would guess that a lot of you on here who have had this would consider this more of a physiological healing than a cosmetic surgery. Last I checked insurance does cover a percentage for seeing a physiologist so in all reality is this much different? I'm sure we can all relate to this case that was won in one way or another.

[asqw]

Isn't this technically a "precedent" or does it not apply because its more of a case by case mattter?

[Paa_Paw]

My suspicion is that this case could be referred to as setting a precedent but not in an overall way. The degree of Psychological impact would still have to be established in each case as well as the degree of breast enlargement.

If the man involved has minimal or no breast enlargement associated with general low self esteem and possible BDD, This case would probably not help him. Conversely, If the breast enlargement is significant and his Psychological issues focus upon the issue of Gynecomastia, Reference to this case may be of great help.