This question has been asked time and time again, but I REALLY want the TRUTH!

[Kill3rK]

Hey everyone! I'm hoping you can help me. Ive been browsing this site + others for some time now, but just recently seriously started considering surgery. I have an appointment set with a plastic surgeon for Thursday, but I have some questions first. My DR. is John Bruno from Ft. Myers, Florida. Does anyone have any experience/ or have the resources to check this doctor out? I have looked at some of his work and it looks pretty good. What will this consultation mainly be about? This is the first time I will have spoken to him. I'm an 18 year old college student, and I am flat broke, so I'm praying that my insurance (Bluecross Blueshield) will cover the surgery. I know I need to tell him I'm in a lot of pain, and I cant sleep at night, but what else? What will really drive home the point that this isn't just cosmetic but medically necessary? Should I mention Breast Cancer in men runs in my family? Which it doesn't, but my grandmother, and great grandmother had it. Please don't comment and say "Well it really is only cosmetic so the chances are slim to none" i know what the chances are, Ive read almost every post like this one, but Ive also read a lot of posts about people successfully getting it covered. One guy said he stuck a needle onto his nipple and made it bleed, and let the blood dry there and showed it to the doc. LOL that's too far for me. Also, I know its not recommended that you drive after the surgery, but what if I hang out in the hospital for a bit? Because ill be having this surgery done on my own, no one will know.

[Dr. Elliot Jacobs]

Every insurance company has its own set of guidelines concerning eligibility for coverage for gyne surgery.  Some companies are more liberal than others.  it would behoove you to research YOUR company's set of guidelines and as much as possible, try to comply with them.  Realistically speaking, though, if you are a regular guy with moderate sized gyne, te insurance companies are loathe to cover the surgery.

As for driving home after surgery, not a good idea at all.  You are very dangerous to yourself and to others.  You should wait at least 24 hours after having received all types of drugs.

Dr Jacobs

[Litlriki]

I agree with Dr. Jacobs.  All of the things you're saying regarding pain and so on may support coverage, but BCBS in Massachusetts also has a stipulation regarding the amount of tissue that's removed, and their criteria are very similar to the criteria for treatment of women with large breasts, meaning a certain amount of tissue needs to be removed.  Most gynecomastia procedures in normal-weight men will not yield enough to meet the criteria. The issue of breast cancer will lead to you undergoing a multitude of tests--mammograms and ultrasounds, maybe a needle biopsy of the tissue, but it won't get the procedure covered.

The process of obtaining prior authorization for gynecomastia is problematic as well, in that insurance companies reply to these requests with a letter which states at the end that "prior authorization does not guarantee payment."  What that means is that you may go into the procedure thinking that you're covered, only to find out that your insurance company doesn't pay afterwards, leaving you responsible for the bills.  When this happens, the bills may be higher than what they would be if the procedure is arranged as cosmetic, with a pre-determined fee for the anesthesia and facility.  Insurance billing is different from billing for cosmetic procedures.  You should be sure to know your surgeon's policies for this.

Good luck,

Rick Silverman