What do I have to do to get insurance to cover surgery?

[Mibu]

I am 5.11, 210 pounds and pretty sure I have gynecomastia. They're psychologically devastating. I work my ass off exercising. My arms and legs are strong and getting pretty toned, but I feel like the boobs never shrink. I feel like I can never take my shirt off in public, never have sex without my shirt, or keep a woman with this condition. What do I have to tell my doctor to have him convince my insurance to pay for it? I won't be able to afford to pay for it on my own, by a long shot. I can't even afford to pay rent on my own yet.

I will be seeing my doctor later this week. So if you have any serious suggestions that could help, I'd appreciate it.

[Dr. Elliot Jacobs]

You can certainly inquire of your insurance company -- they have guidelines under which they may cover gyne surgery.  You should be aware of the criteria of the insurance company before your visit to a PS.

Once you visit your PS, he may be able to write a letter on your behalf to the insurance company.  Don't put much stock into it, though.  Insurance companies are loathe to cover gyne surgery.

Dr Jacobs

[Paa_Paw]

Your Insurance should cover the cost of seeing a Psychologist for depression. A letter from this specialist could also be of help.

Surgery for depression? For anyone who really understands the impact that this condition can have on a young man this is not at all hard to understand.

[15yrsl8r]

I am 5'6" tall and at one time in my life weighed 215lbs. At the time of my first consultation i weighed 175lbs, however my total weight loss in the year 2000 was over 75lbs.

After years of research and agonizing emotional problems, I knew it would be unlikely for insurance to pay for any corrections. The surgeon warned me to expect a denial. He said they would appeal but to expect another denial. To our surprise, I had no denials.

He billed it as bilateral mastectomy reconstruction due to gyne. And he mentioned my 75+lb weight loss. He and other doctors that I have spoken with have said there is limited success after excessive weight loss. More luck with woman than with men.

I do feel blessed because I could not afford the surgery without the insurance paying 80%. He did not bill for lipo, so $10,000+ surgery was reduced to $7,000. All said and done, my bill is just under $2,000.

Best wishes man!

https://www.gynecomastia.org/smf/index.php?topic=22303.0
my before and after