How to find out if insurance will pay for the surgery???

[efrain]

I have read a few posts where insurance paid for the surgery.
How can I find out if my insurance will pay?

If your insurance Co. paid for your surgery, please let me know the process.

Thanks

[Grandpa Bambu]

Give your Ins. Co. a call. Ask them if they cover Gynecomastic Reduction Surgery. Or, maybe it be better if you went through your GP.

GB

[efrain]

Give your Ins. Co. a call. Ask them if they cover Gynecomastic Reduction Surgery. Or, maybe it be better if you went through your GP.

GB

I just called my Ins. Co. and they had no idea what Gynecomastia was.  They said a claim would need to be submitted by my Dr. 

Grandpa... did you try and run your surgery through insurance?

Oh ya... Kewl Ink

Thanks

[Grandpa Bambu]

I just called my Ins. Co. and they had no idea what Gynecomastia was.  They said a claim would need to be submitted by my Dr.

Yeah, thought that might be the case. The medical term is 'Bi-Lateral Excision' (I think). My memory is bad, sorry dude.

Grandpa... did you try and run your surgery through insurance?

Excision and hospital fees were paid by government sponsored health care plan (O.H.I.P.). I knew in advance that OHIP would pay for Excision and hosp fees.

Oh ya... Kewl Ink

Thanks dude...   

GB

[efrain]

After reading the following link, it does not seem like CIGNA will pay for the proceedure:

http://www.cigna.com/customer_care/healthcare_professional/coverage_positions/medical/mm_0195_coveragepositioncriteria_surgical_treatment_of_gynecomastia.pdf

How did you know in advance that you would get covered?

Thanks

[Grandpa Bambu]

efrain...

Thanks for info dude. Very interesting read.

Wow, that's major criteria that a guy has to meet in order to have CIGNA cover surgery cost.

CIGNA referred to Gynecomastia as a 'Disease'. Gynecomastia is not a disease.

Merriam-Webster Online Dictionary defines 'Disease' as:

2: a condition of the living animal or plant body or of one of its parts that impairs normal functioning and is typically manifested by distinguishing signs and symptoms.

Impairs normal functioning of a body 'part'. Gynecomastia does not do this. Gynecomastia is a 'Condition' not a disease.


Also... I found it very interesting that CIGNA recognizes that Liposuction, as a sole method of treatment for Gynecomastia, is 'unproven'. I also find it very interesting as to why so many PS's push 'Lipo only' procedures to treat gyne.

How did you know in advance that you would get covered?

When I first registered on this Site in Nov. '04, I was chatting with 'FB' (formerly 'Freezer Burnt', another JCF patient) who at the time, just had his gyne removed. He told me that O.H.I.P. (Ontario Health Insurance Program) pays for all except Lipo. Shortly after that, I contacted Dr. Fielding for a consultation...

GB

[headheldhigh01]

it's a tough sell, but avoiding the term gyne in favor of bilateral excision like he says might help, plus the argument made by the doc.  most don't cover it, but it will always depend some on the individuals you're dealing with. 

[aman1982]

I got my insurance to pay for most of my surgery.

Here is what I did.

1. Wrote a professional letter to my insurance company requesting they pay for it.
2. They rejected my request as they said it was cosmetic
3. I appealed the decision and included a family doctors letter which stated i had tenderness in my nipple area since puberty and was uncomfortable when i worked out.
4.  The insurance company rejected.
5.  I sent another letter stating that my family doctor had vouched that the surgery was being performed for physical pain and not for cosmetic reasons.  Not covering was a vouch in my policies coverage since it was painfull.
6.  The insurance company agreed to pay as long as the results from a biospy showed it was gyne.

In summary... Be as "Professional" as possible and keep track of your contacts.   Make note of the days you sent the previous letters in you appeals.  You have to understand that insurance companies to not want to be sued or taken to court (due to bad press).  Make them beleive that you are serious and the procedure should be covered!