Author Topic: Proving medical need for surgery  (Read 3328 times)

Offline Swim

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Okay, so to get insurrance coverage I have to "prove" to my GP that getting the surgery is a medical need so he can authorize it.  Anyone have any ideas on how to do this effectively, because money is somewhat of an issue for me since i'm in college  :-/    I'd appreciate any ideas!

Offline nukem2k5

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Say that it hurts you all the time.
Reborn on May 24, 2005
Surgery Cost: $4,040
Dr. David Metzner - New Orleans, LA
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Two Years Post-Op Photos

Offline Swim

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Quote
Say that it hurts you all the time.

Physically or psychologically?

Offline rcbrown23

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physically. Say that there sore all the time and it bothers you a lot.

If your GP is someone you've been going to for awhile, then he/she shouldn't have a problem. It's not out of his pocket or anything, just tell him you need a letter from him for insurance to cover it.

Offline Swim

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haha they don't really hurt all that much but i can say that. unfortunatly my doctor just switched clinics so i'm going to visit a new doctor.  so it will be harder to convince him since he doesnt know me that well.  if they interfere with my work (I lifeguard and swim)  would that be a good thing to tell him?

Offline nukem2k5

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It may actually be better that the doc is new because you can begin by saying that they hurt you all the time (physically) and he wouldn't have any reason to not believe you.  Maybe since you're a lifeguard you should say that they hurt a lot when you run, also, and its often painful to do your job.  I hope it works for you.

Offline Grandpa Bambu

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The only way that I know of to get an Insurance Co. to pay for surgery is if you have breast cancer or other 'proven' medical condition. An Insurance Co. will want to see 'proof of', not just a letter from your GP.

Insurance Companies are reluctant to recognize psychological pain and suffering. Bastards, the lot.  >:(  

Insurance Companies are bottom feeders! :P

John.
« Last Edit: April 21, 2005, 06:52:55 PM by Bambu »
Surgery: February 16, 2005. - Toronto, Ontario Canada.
Surgeon: Dr. John Craig Fielding   M.D.   F.R.C.S. (C) (416.766.8890)
Pre-Op/Post-Op Pics

Offline boobhater22

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When I was 14, I was approved by the insurance company (do not know which) to get it covered. However, my dad told me it would go away with exercise and that I shouldn't get it, so I didn't end up getting it. That was 8-9 years ago. I was and am pretty extreme, but I had lost a ton of weight and was very thin at the time...yet still had some boobs...which were not as big as before (or now), but still large...and there was also sagging, excess skin.

I have no idea why I was approved, but i did not have cancer. I saw a plastic surgeon, had some tests done on me (i am assuming they were endo tests, but don't know--i think they invovled hormone levels), and they took photos, and sent some things to the insurance company. I was only 14 and was not involved in the process in any way, so I have no clue what was said/written to the insurance company. I am sure the doctor must have done all of that for me.

In general I would speculate that I don't think insuracne companies cover people who are overweight--so you should be at your ideal body weight before you attempt to get the insurance company to cover it. In fact, i think i read this somewhere online. So if you are overweight, you'd need to lose the pounds first.

If i were to try and get an insurance company to cover me now...I would probably say they hurt--that is a good idea--and i would also go to a psychologist and tell him I am suffering from severe derpession due to boobs and want to kill myself because of my boobs. Maybe even say you tried to kill yourself once, but a friend stopped you--like he found you with a gun and talked you out of killing yourself. That would be a lie (in my case), but ... it could be more amunition to use with the insurance company. Just don't go so overboard that they hospitalize you or anythign!!  i really have NO IDEA WHATSOEVER if it would work, but it's worth a try, i'd say.

I wish I had insurance now so I could try to get covered again and lose the boobs (when i lose the rest of my weight), but alas...I am too poor for insurance! And I have read online that it is next to impossible to get covered by insurances. So, even though i was going to be covered 8-9 years ago, I would be doubtful that I could get covered again...just based on what i have read online.

Offline Paa_Paw

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This is very difficult.  But it can be done.  The following are not in any order.  Depending on your own situation,
you may work on each individually or you could work on them concurrently.

An Endocrinologist could establish that there is not a condition still existant that might cause re-growth.  This same doctor could also provide evidence that you have reached a degree of physical maturity that you are a good candidate for surgery and that self resolution is not likely.

A psychologist could evaluate you and address issues of self image, embarassment, social isolation, occupational problems etc.

Letters from both can sometimes get coverage when the Insurance Company would otherwise automatically deny the surgery.

On the other hand, since you have already been told to give a reason why the surgery is a medical necessity; These doctors may find that your Gynecomastia is so minor and lacking in psychological impact that surgery is not warranted.

Psychological impact is often a key issue, but it only works if the Gynecomastia is obvious and the impact on your ability to socialize are severe.

While seeing these specialists, a wise idea might be to hope for the best while you prepare for the worst.  In other words: While you attempt to put together an argument supportive of medical necessity, start saving in case you ultimately have to pay cash.

Good Luck
Grandpa Dan

Offline Swim

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So addressing the weight issue, i'm 5'9, 150 and really inshape, so thats not the problem.  :)  

The endocrinologist said that there was no way he could correct it because my hormones were at a normal level and the gynecomastia isn't going to resolve by itself.  So I can use that, and that it interferes with my job and my passion of swimming.   I'm not quite sure if i want to sound crazy and go to a psychologist, because i dont have any serious problems like that, i live a normal life.  ahhh i'm not sure what to do  ???

Offline hypo

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Boobhater,

You should request copies of your medical records to find out just what was found during hormone testing.

If something was amiss you may require treatment.

Offline boobhater22

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I have asked my mother to do that about a month ago, but so far she has not responded. I will have to remind her again.

From my memory...I believe my hormone levels were normal, but i did not get to personally examine the tests and compare the date with accepted standards myself, so I really can't be absolutely positive.

Offline Paa_Paw

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I said a Psychologist, To help with a letter regarding the impact of Gynecomastia on self image, socialization etc.  If I had thought you were nuts I would have said a Psychiatrist.  I do not think you need a psychiatrist, but a Psychologist could be helpful.

To reinforce what Hypo said, If your Estrogens were at the high end of normal but Androgens were at the low end of normal; the relationship between them could be a problem.  It is important to know the actual numbers because some "Normal" ranges include all healthy males without allowance for age.  Interpretation of those numbers I will leave to others who are much more familiar with such things than I.


 

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