one step to get my health insurance covers gyno

[alex1001]

Hi all

finally after years of suffering from my gyno i decided to have the surgery.
well my decision came late, after i missed all the years when i was a teen and my friends were hanging out to the beach ( it was really good times). but after i decided to have the operation, i'll make up those times again to know the feelings thats my friends had.

ok, i'll just go into my topic,
i live in australia as i work for a company, ( they sent me here to work for 4 years then go back to my country). I have a private health insurance which doenst cover gyno. in these cases the company could cover the full cost if the doctor describes it as a necessary procedure and not a cosmetic.
 
when i visited the surgeon i told him if he can write a medical report that explains my condition and tells my health insurance it is a necessary procedure, and if it isnt done it could lead to physical problems ( it could get bigger and becomes a tumor) and he smiled and told me dont worry we are good in these stuff.
 
the doctor wrote a "medical report" describing my condition focussing on how this condition could impact on my mental and social status, but sadly the company didnt find this is an important cause to pay for the surgery.

Now, what should i tell the doctor to write? how i convince him to write something that really will convince the health insurance to pay for it??

[Raider Fan]

Welcome to gyne.org., alex1001. 

Remember that the insurance company has heard and seen it all.  You are certainly not the first one that has ever approached them about having surgery for your gynecomastia.  They have their policies, and that's what they will go by.  You are probably 1 of thousands of people who have asked them about this. 

Unfortunately, unless the surgery truly IS for health reasons (i.e., you have a tumor or some other true disease or medical reason), this surgery typically is not covered.  That's because most insurance companies consider it cosmetic surgery only, not for health reasons.  And for most, that's exactly what it is because gynecomastia is not a physical danger.  It will not shorten your life by even one day.  Sure, it can be a detriment to our emotional or mental health, but the insurance company doesn't base their decisions on that....only if it's needed for our PHYSICAL health. 

   

[jojo82]

I'm familiar with the process for a couple of US insurers from personal experience, but not Australian insurers. Sorry- wish I could help.

[alex1001]

Welcome to gyne.org., alex1001. 

Remember that the insurance company has heard and seen it all.  You are certainly not the first one that has ever approached them about having surgery for your gynecomastia.  They have their policies, and that's what they will go by.  You are probably 1 of thousands of people who have asked them about this. 

Unfortunately, unless the surgery truly IS for health reasons (i.e., you have a tumor or some other true disease or medical reason), this surgery typically is not covered.  That's because most insurance companies consider it cosmetic surgery only, not for health reasons.  And for most, that's exactly what it is because gynecomastia is not a physical danger.  It will not shorten your life by even one day.  Sure, it can be a detriment to our emotional or mental health, but the insurance company doesn't base their decisions on that....only if it's needed for our PHYSICAL health. 

   

well said, i just had my consultation with the doc and told me the same.
i think i'll have to pay for it in order to live my life,, right?

thanks for your comment Raider Fan

[alex1001]

I'm familiar with the process for a couple of US insurers from personal experience, but not Australian insurers. Sorry- wish I could help.

well, i think they all share the same thing " NOT accepting gyno cases"