Surgery covered by Insurance with a catch. Please Read and comment

[blueturtle80085]

Hi there,

I'm a 24 year old male that suffers from gynecomastia (as I've posted before). I've spent two years quietly researching and consulting with my Primary Care Pyshcian about my best option. I've always wanted to have surgery as that's the only option that will take care of this underlying issue. My glands are bigger then golf balls and it is extremely noticeable. There isn't much fat but I've figured I would need some liposuction for best results.

I have had my PCP work with Anthem (my insurance company) but anytime she has submitted paperwork, even with the approval of an endocrinologist the claim has come back "denied" because it has suggest liposcution along with gland removal.

Finally, about a month ago I got a letter from my insurance company stating that it would cover all costs associated with a procedure called "mastectomy for gynecomastia". This includes anesthesia, hospital stay, excision etc. etc. as deemed necesarry by the surgeon.

The catch is that the insurance company is requiring that I have the procedure done with "Jane Doe".  Through consulation with "Jane Doe" I know she performs a handful of these procedures every year and has done so for several years. She only does these for medical reasons and states up front she is not a plastic surgeon and will not being doing ANY liposuction although she agrees that I would have only needed minimal liposuction because there are not a lot of fat deposits under my nipple.

I am in a bind as to wether or not I should proceed with the surgery. I've been told by "Jane Doe" to be realistic with my expectations... That because I am young and my skin is elastic I should have good results, and that because she has performed many of these with a peri-areola excision I should not worry much about scaring... BUT her caveat was that again she is NOT a plastic surgeon and because she is not doing any lipo I should not expect to have the chest shape of the male fitness models in the magazines.

As of right now I'm confused. If I have this surgery before the end of the year I won't pay a penny out of pocket because I've already reached my insurance deductible and anything afterwards, as long as it is approved by my insurance company (as this will be, I have it in writing) is free.


I feel like if I have the  glands removed, even if it is only 60% better, that is a big improvement. I may at a later date need liposuction but I have that understanding going in...


Please feel free to comment and leave any words of wisdom or advice concerning my situation. It would be greatly appreciated.

Thanks,

Ed

[mrstew12]

Im a lil lost
would anyone else be able to pull this off

[KAG]

Not sure how to tell you this without sounding negative or discouraging you. I went through the same thing basicly with a general surgeon....the results were terrible and honestly not very good.

THEN try finding a "GOOD" surgeon to help you....almost impossible because they would have to admit the 1st surgeon did a poor job. All the plastic surgeons i saw afterwards said"why did you let a general surgeon do this" I said I did what i was told by my doctor. They actually didn't beileve me....it was kinda of crazy but the medical communinty acts like you should KNOW better. Made me VERY suspicious and gun shy to EVER try getting this fixed by other doctors.

I've had them lie about it and tell me lipo would fix it etc etc etc.

I'll tell you this YOU BETTER prepare yourself and know as much as you can about this before getting it done. Get the surgeons attention and be on the same page.

I think if you read between the lines on this site you will come to realize it takes an EXTREMELY talented and experienced surgeon to resolve gyne properly.

If you go through with this PLEASE take pictures yourself and make sure you tell "jane" you expect results acceptable that you can take your shirt off in public. I CERTAINLY CAN NOT<

General surgeons usually end up putting two large craters into your chest and two long scars......actually looks worse if you ask me.

Good Luck and God Bless you and look over you.

[moobsbrah]

I agree with the above poster. It is very important to see a board-certified plastic surgeon, because this is their craft and what they trained for. A general surgeon is great at what they do (breast cancers, abdominal parts removal) etc, and probably better than a PS at those procedures since they do them for a living. But gynecomastia surgery (or any cosmetic surgery) is way out of their element. Also, the fact that lipo is off the table should be a red flag. To directly quote Dr. Jacobs from another thread, "Liposuction is one of the mainstays of gyne surgery.  It is used to remove excess tissue (fat and/or gland) of the chest in areas away from the nipple.  It also smooths (surgeons call it "feathering") the edges of the operated upon area into the normal and undisturbed areas of the chest. This is what provides a smooth contoured chest. If only excision is done, there is a good chance of cratering.[/b]" http://www.gynecomastia.org/smf/index.php?topic=18673.0

I know you want to get it done ASAP (as I did years ago), but just forget about the insurance and work on saving money, because there is a high probability that you end up scarred for life and needing a revision (which can be more expensive), if you use a GS. Best of luck

[Grandpa Bambu]

Try this...

Consult a qualified/experienced PS of your choosing, get him/her to submit papers to your insurance company for excision only. Then, have your PS perform lipo during the surgery but pay for the lipo yourself... Your ins. co. doesn't have to know that you've had lipo...

Problem solved!!! 


Do not go to a general surgeon for G reduction...  or you'll be very sorry you did! 

GB...