why is gynecomastia reduction considered cosmetic surgery?

[moobiesfighter]

anybody think it shouldn't be and why?

[gettingrid]

It is probably cosmetic by definition but I dont think it should be put in the same category as just getting some adjustment to a nose chin etc made. its not like we are trying to win a beauty content here...jsut trying to have a normal life through the surgery.

Due to the severe impact this has on the daily life of men, I think its time some coverage should be provided for this procedure. I think this has bugged me more each and every day than any other single medical problem I have had up until now.

[Mr_Nip]

Unfortunately, conditions that the insurance define as "cosmetic" are defined that way to protect them from having to pay out claims.  Simply put - it's about the money.  It would most likely take a legislative ruling to force the insurance companies to change their definition of the surgery from "cosmetic" to "medical".

[moobiesfighter]

haha let's revolt and make un-cosmetic.
Because this kind of problem effects men mentally..
Im sure it has affected some men so much that suicide has even become an option.
Which I hope none of you take, because this is why this forum was created and this why I take my time to type here because we need to share our stories and teach people what gynecomastia is to fight it.

[DARK LYRICS]

well i just started working for this company and i get free health insurance and yes i have gynecomastia wich sucks bigggggggg time , well ive been reading this forum for the longest and now that i have insurance im gonna play smart than to just go str8 to surgery and to see if my insurance will cover it, from what i know and heard u cant just call ur insurance and say i have gynecomastia and want it removed u have to go take steps for it, like from what i found out on my internet search on the insurance i got, insurance does cover it not all of them but some do like the one i have says it does, so im gonna see if i can work on geting it removed now while i got this insurance, but this is what they lets hope its true because it will be a life saver they say this

Description:


Gynecomastia is the unilateral or bilateral enlargement of male breast tissue.  Mastectomy for gynecomastia is a surgical procedure performed to remove breast glandular tissue from a male with enlarged breasts.  Medications, physiologic states, and medical conditions can alter the balance of androgen and estrogen causing male breast growth. Before considering a type of medical treatment, it is important to keep in mind that gynecomastia has a high rate of spontaneous regression.

Approximately 40-65% of boys develop some degree of gynecomastia during puberty, which usually resolves spontaneously within two years, and rarely requires treatment. Enlargement sufficient to cause embarrassment and social disability occurs in fewer than 10% of those affected by puberty related gynecomastia.

While it is not necessary to evaluate every case of gynecomastia, the presence of an underlying tumor needs to be excluded and treated.

Procedures completed for cosmetic reasons (e.g. embarrassment or social disability) are not payable under the medical contract.

Policy:
Mastectomy for gynecomastia (either pubertal/adolescent-onset gynecomastia that has persisted for a least three years or post pubertal-onset that has persisted for one year may be considered medically necessary when all of the following conditions have been met:

Glandular breast tissue confirming true gynecomastia is documented on physical exam and/or mammography.
The gynecomastia is classified as Grade II, III or IV per the American Society of Plastic Surgeons Classification, (See below)
The condition is associated with documented persistent breast pain, despite the use of analgesics.
The gynecomastia persists, despite correction or treatment of underlying causes including:
Hormonal causes
Potential gynecomastia-inducing drugs and substances
Photographs have been submitted confirming the presence of the gynecomastia.
Mastectomy for gynecomastia is considered medically necessary if the member has documented enlargement with questionable malignancy, or the presence of nipple discharge. Usually present as a unilateral eccentric mass, hard or firm, that is fixed to the underlying tissues.   




Mastectomy for gynecomastia is considered not medically necessary under any of the following circumstances:
If the criteria listed above are not met
If the surgery is performed for psychological reasons
Breast enlargement resulting from obesity, or 
Breast enlargement resulting from medications

[LMC1307]

Because life is not fair, people are selfish and money hungry, and as much as I hate the system, I do afterall believe that it is somewhat cosmetic. I understand we are trying to live a normal life in getting this surgery, but in my case, I would almost lump it in the same category as getting a nose job or something. It is just bad genetics that we are born with, just like someone with a bad nose, and that's just how the cards are dealt. But, I do believe in certain moderate-extreme cases, it should definitely be covered by insurance.

[cody sockeye]

Isn't breast reduction in women considered "reconstructive"? I believe it is, though I could be mistaken. And since it's "cosmetic" in men, that'd be like saying breasts are normal with us but not normal in women...

[GrandMstrBud]

My insurance says the same thing but when I went to see a PS for a consultation he said it's "not covered by insurance". I wonder if we all get together if we can change the way this is handled. Most of us want this because of the way it looks but it also has mental effects. I for one have avoided so many things in my life because of it and I simply can not afford the surgery.

[Grandpa Bambu]

Most of us want this because of the way it looks but it also has mental effects. I for one have avoided so many things in my life because of it and I simply can not afford the surgery.

Insurance Companies don't concern themselves with cosmetics or psychological issues.

Mastectomy for gynecomastia is considered not medically necessary under any of the following circumstances:  If the surgery is performed for psychological reasons.

GB

[Grandpa Bambu]

Insurance does cover it not all of them but some do like the one i have says it does, so im gonna see if i can work on geting it removed now while i got this insurance, but this is what they lets hope its true because it will be a life saver they say this


Policy:
Mastectomy for gynecomastia (either pubertal/adolescent-onset gynecomastia that has persisted for a least three years or post pubertal-onset that has persisted for one year may be considered medically necessary when all of the following conditions have been met:

Glandular breast tissue confirming true gynecomastia is documented on physical exam and/or mammography.
The gynecomastia is classified as Grade II, III or IV per the American Society of Plastic Surgeons Classification, (See below)
The condition is associated with documented persistent breast pain, despite the use of analgesics.
The gynecomastia persists, despite correction or treatment of underlying causes including:
Hormonal causes
Potential gynecomastia-inducing drugs and substances
Photographs have been submitted confirming the presence of the gynecomastia.
Mastectomy for gynecomastia is considered medically necessary if the member has documented enlargement with questionable malignancy, or the presence of nipple discharge. Usually present as a unilateral eccentric mass, hard or firm, that is fixed to the underlying tissues.

   


Sounds like they will put you through the ringer.... 

I wonder if IC's get to choose the surgeon. Prolly huh? I'd be a tad concerned with that. If you do manage to get your IC to flip the bill for you and they are the ones who choose the surgeon, ask the IC who that surgeon is (if possible) and do some research on them. If they are not 'up to par' (credentials not very good), then if I were you, I'd say fuggedaboutit....

Best of luck!

GB