help with insurance

[lugg47]

I need some help. I have had gynecomastia since around the age of 12. I am now 19 and I've been kicking around the idea of surgery forever, probably since I was 15, but I've been giving it some serious thought in the past year and have gone through all sorts of possibilities to take care of my problem. Last summer, I thought I could get a summer job to pay for the surgery, and I saved around $2,000 but realized that with school starting and my job ending, I found out this idea was extremely stupid. Around Christmas, I thought I found a solution by getting a loan for my surgery. I knew I could definitely handle making monthly payments. Then, I wasn't sure if because I'm under 21 if I would need someone to co-sign because I really didn't want my mom to find out I took a loan until I got the money because I want to handle paying for it on my own. On top of that, I didn't know anywhere that would give a 19 year-old kid with only a summer job $3,000-$6,000. Out of curiosity, I wondered what the policy was for a gynecomastia surgery on my (mom's) insurance. I knew the chance of any coverage was slim, but I could at least check. I found some things, but I really need help interpreting them. First off, the insurance plan is Highmark Blue Cross Blue Shield. I've read some places that sometimes they cover the surgery. I ended up finding a policy called cosmetic vs. reconstructive surgery. Anyways, here's what I found:

Managed Care: The leading cause of enlarged breasts in males is obesity. In order for mastectomy for gynecomastia (19300) to be considered reconstructive rather than cosmetic surgery, the following guidelines should be applies:
Ages 5 - 18 years - The patient must be below the 97th percentile for weight based on height as indicated on the standard pediatric growth and development chart (See the Table Attachment below).


Ages 19 - 24 years - The patient's weight must be within the ideal weight for a 25 year old as indicated on the Metropolitan Life Height and Weight Table for Men. (The ideal weight for 19 24 years is the same, or close to, the 25 year weights because this age range is past puberty.) (See the Table Attachment below).


Ages 25 - 59 years - The patient's weight must be within the ideal body weight as indicated on the Metropolitan Life Height and Weight Table for Men (See the Table Attachment below).

If the patient's weight does not fall within these guidelines, the surgery will be considered cosmetic until the pathology report confirms that the tissue removed was primarily breast (ductal) rather than adipose (fat) tissue.

A weight chart was given and I would fit into the ideal weight category for my height.

Next, under the section titled "Covered Procedures," I found this:

Mastectomy for gynecomastia (19300): If it is documented that the tissue is primarily breast tissue and not just adipose (fatty) tissue. If the tissue removed is primarily fatty tissue, the surgery is classified as cosmetic and is not eligible for payment.

The way I understand this is that it says the surgery is covered under these guidelines. For anyone who has experience with insurance covering or not covering the surgery, can you please help me with your thoughts. With so many people not having this covered, I am wondering if there will be a catch to this or will they only cover minimal amounts of the cost. I figured I would ask here first rather than call the insurance company because some of you guys here have dealt with this first hand and it would be easier to get some opinions on what to do first before I move further with the insurance thing. Thank You in advance if you can provide me with even the smallest amount of information.