Insurance

[ff360]

I know most insurance doesnt cover the surgery but does anyone know if Connecticare Insurance covers gynecomastia surgery???

[Dr. Elliot Jacobs]

You understand that most insurance companies consider gyne surgery to be a cosmetic procedure.  But I would suggest you contact the insurance company and request their specific criteria for gyne surgery to be considered as a covered expense.  Then compare your own situation -- you may be able to answer the question yourself.

Best of luck!

Dr Jacobs

[tomtom5418]

All i have to say to you is....  try try try!!!   ...I got mine covered under insurance...and it does happen more times than people on here say it does.   

It helps if you are not obese and are young

your insurance company will have certain criteria though just like Dr. Jacobs said.

Good Luck!

[KE25]

I am reopenig this thread because I don't think it is worth starting a new one. I found the Medical review Criteria from my health plan.

https://www.harvardpilgrim.org/pls/portal/docs/PAGE/PROVIDERS/MEDMGMT/MEDICAL_REVIEW_CRITERIA/GYNECOMASTIA%20SURGERY_REV2_0409.PDF

How can I determine what grade I have?

[Dr. Elliot Jacobs]

You will have to consult a surgeon about this -- he will be aware of the grading system and be able to tell you.

Dr Jacobs

[Paa_Paw]

I find it interesting that one of the exclusions is when Psychological stress is the primary reason for treatment.

If the psychological stress could be eliminated entirely without surgery it would seem that there would be not much need for surgery.

Am I missing something here?

[Dr. Elliot Jacobs]

No -- you are not missing anything.  Insurance companies are NOT your friend.  They will do anything to deny coverage for you.  It means more money in their pockets (and the pockets of the CEO's and shareholders).

Yet, woe be to you if you are late with an insurance payment!!  They will quickly deny coverage for anything because you were uninsured.

Bottom line:  it takes almost extraordinary circumstances or effort on the part of a patient to convince an insurance company to cover gyne surgery -- and even if they do, they use every conceivable means to reduce the amount they will reimburse to you.  They especially like to use the fine print of the contract to reduce any payments.

I live with this every day -- it is extremely frustrating!

Dr Jacobs

[headheldhigh01]

which is true, although this was an interesting thread a while back too. 

http://www.gynecomastia.org/smf/index.php?topic=9474.0