Medicare and Gynecomastia

[Denman]

Just wondering if anyone knows the latest on successfully getting Medicare to pay for surgery. Has anyone done this? And what doctors are out there who honor original Medicare, I have part N. One clinic I spoke to said they don't do any insurance, so I guess that includes Medicare. 

[42CSurprise!]

I can't answer that particular question but discussions about availability of insurance to remove breasts because they appear on a man's chest have always been told this is not a "medical issue."  I guess that means that being a man with breasts is not considering a health problem.  It may be a problem psychologically for men accustomed to seeing other men with flat chests.  I guess the corollary would be women who have flat chests who go to a plastic surgeon for implants.  That isn't covered by insurance either.  Adding or removing breasts is a matter of personal choice not medical necessity.  I expect the same it true with Medicare... unless there is cancer that would be addressed through a mastectomy.  Good luck sorting it out.

[Justagirl💃]

I'm on a Medicare advantage plan, and surgery has been suggested to be several times. The Psychiatrist is under the impression that "fitting in" would be beneficial to my psychiatric  health. Completely paid for under my current plan. 

I have declined every time, as I love my breasts and can't images life without them. 

My advantage plan is the PACE program. But that entails relinquishing most of your medical rights to the program.  A system that I will be leaving upon moving to Oregon. 

[WPW717]

Hell, I can’t even get Medicare docs to order guideline tests for MEN Syndrome, & when they do the radiologist or pharmacists put the kaibash on the order. That’s why I progressed to significant osteoporosis.

Starting over here in Tennessee in a different community.

[Justagirl💃]

Hell, I can’t even get Medicare docs to order guideline tests for MEN Syndrome, & when they do the radiologist or pharmacists put the kaibash on the order. That’s why I progressed to significant osteoporosis.

Starting over here in Tennessee in a different community.

MEN syndrome is a hidden infliction.  

The only reason why the PACE program offers the double mastectomy in my case is because I'm an embarrassment to them. They have a much bigger problem about it than I do. 

The other thing about the PACE program is your right to a second opinion goes away. Whatever the doctor decides goes, right or wrong.  

[gotgyne]

By the way: A man with breasts stays a man, as a woman after a bilateral mastectomy for cancer or the risk of cancer (BRCA genes) stays a woman. Thus why to remove them in men if there is no risk for health?

And moreover: Some young and many older men have visible breasts and don't care what other people think of it.

[WPW717]

Hidden affliction!, you got that right, Birdie. It’s even hidden from most doctors.

It started subtly in 1980. Then it progressed until it burst into a full blown health crisis in 2018. The resolution came finally after a series of surgeries that left me feeling less than happy and human. I handed them the MEN diagnosis and they ignored the possibility for a year.

In defense of health care the genetic testing wasn’t available in 1980 to hone in on this like it can be today.
But the syndrome was known about back then and there was a way to diagnose it.

Today it  is easy to do a genetic profile to assess whether or not the syndrome is present before it manifests into the problems that follow. If even one leg of the triad manifests then do the test. But the government & insurers have inserted themselves between doctors and patients all for the almighty dollar.

Now on Medicare I find they save money by denying patients the services they need until there is a harsh pushback and then it’s still an inadequate care, hence my osteoporosis manifested that was avoidable. 

Rant over, I am now in Tennessee & near a new healthcare system that shows a bit of promise to deal with this rare condition.
It’s lovely here and am enjoying my new digs.
 

[Denman]

Well, I have to say that all of your replies are generally unhelpful and off topic. Gyne can be a health issue for men due to physical pain. It does not have a corollary in female breast implants that are fully cosmetic; I am not asking that my pecs be augmented so that people think I have been to the gym.

So returning to my OP, gyne can be treated under Medicare under certain circumstances, but finding a doctor who is participates in Medicare is very difficult and that is what I was asking about. 

[50/50]

When I was considering getting my breasts removed Medicare would not cover it. Elective surgery. But Medicare and my supplement has covered all cost trying to find out why my breasts grew involving several tests. They even paid for my mammogram. I have accepted the way I am with the help of my wife. I have learned how to hide them somewhat with clothing and certain bras.
Medicare pays for my health exam once a year that includes my breast exam as well. All is good. I have totally embraced who I am. Love yourself for who you are.😄

[WPW717]

Denman, perhaps you misunderstood the rant. I felt the pain of growth, I had issues that not one doctor in 2+ years ever chose to examine my rapidly progressing gynecomastia.
Not one was even interested in investigating the cause.
For Medicare docs to not investigate the cause of gyne was a travesty of practice. The cause was 3 tumors acting in concert to cause the gynecomastia, and a lot more. 
I have a Medicare advantage plan & a plan G in the past. 
This is off topic?

[Justagirl💃]

whether or not Medicare/advantage plan pays for surgery depends largely on the doctors, specialists, etc... 

In my case the psychiatrist determined that surgery would be necessary for my psychiatric health and mentioned surgery several times.  She was also wrong and misdiagnosing me based off her own opinions and not my actions and conversations. 'Her' need for me to "fit in" were being projected back on me wrongly. 

Had I really wanted surgery (I don't), the plan would have paid for it for my psychiatric health determined by my care plan.  

cosmetic surgery, because you don't like them, would not be covered. Extreme anxiety or depression because you have them might qualify if written up properly in your care plan. Asking your GP to write up an order will not work, you would need a psychiatrist to evaluate you for extreme depression and anxiety first and have them recommend surgery.  

then it's up to your advantage plan on if it's covered. 

[FredL]

in researching my surgery, I found something that didn't seem fair. Generally, insurance views breast removal for women transition to men as a medically necessary reconstructive procedure for the treatment of gender dysphoria. There will be some amount of coverage. Not the case for a man with gynecomastia wishing for a flat chest. No coverage. 

I'd like to know how a biological man a wanting a procedure for a manly chest is any different than a biological woman wanting the same thing. In both cases it's physical and psychological.