was told that Medicaid would cover gynecomastia....

[MedicaidMaybe]

I've lived with this problem since i was a kid and now that i'm 37 years old, i'm finding out there might be something to do to fix it! In inquiring about the procedure with some local doctors, I found out that Medicaid would cover it. Sadly, I've been out of work for a year now and just sinking deeper into a depression. This is the first ray of light I've seen in a long time. It doesn't require a referral, but it does require pre-auth. The only thing is that I'm scared that this won't happen for one reason or another, regardless of all of that good stuff.

Does anyone have any experience with this (ie with Medicaid) and how possible it might be that this could happen? I don't want to get my hopes up too much, you know? I have my consultation tomorrow to see what the doctor says and I guess we'll go from there.

I'm wondering, if her feels that the procedure is neccessary, how long the preauth process takes or how long it takes to get the surgery done, once all is in place? I'm hoping for sooner rather than later. I have lived with this so long, it's nice ot finally see a possible light at the end of the tunnel. I am a little concerned about any pain associated with this. My threshold isn't too high and I don't know what they prescribe after the procedure or how much, but I tend to be a bit of a lightweight with tolerance to pain.


Thanks for any assistance you can provide. I just hope this all made sense. The doctor I am going to see is Dr. Warren Schutte, anyone know his reputation?

[George Pope, M.D.]

I've really never heard of Medicaid covering this. 

Dr. Pope, MD

[MedicaidMaybe]

This is two excerpts from two seperate emails I received from the doctor's office:

"If you are under Medicaid we are more than happy to evaluate you and send in the preauthorization request for this procedure. This procedure is not done in our office, but at a surgery center therefore the facility fees and anesthesia fees are not under our control."

and

"Figured I would get back to you in regards to helping you out with this whole insurance process.That is great news to hear you have been approved with Medicaid!  We would be more than happy to set up a free consultation with you to do an evaluation as well as get preauthorization started at that point."

If I get a consultation and am ready to move forward with the procedure, I'll be devistated if it doesn't cover it. They've been so positive that it does in all of their emails with me. Do you have any thoughts on why they would lead me down that path if it didn't cover it?

Have you ever heard of this procedure being done pro-bono? I am in Colorado, if that helps at all with my questions. Thank you for the quick response!

[Paa_Paw]

I have never heard of Medicaid covering this. Then again, I guess there is always a first time. Good luck!

[George Pope, M.D.]

Most commercial insurance companies do not cover gynecomastia surgery, and historically, Medicaid does NOT cover most of what commercial insurance companies DO cover.  I never even bill Medicaid for trauma cases I do when I am on ER call, when patients have Medicaid, because they don't even pay for trauma cases, in my experience.  The one situation where they typically pay well is with children, like tonsillectomies, PE tubes, cleft lip and palate surgery, etc.

Most doctors don't accept Medicaid because they JUST DON'T PAY.  I hate to burst your bubble; I just don't want you to get your hopes up.

Dr. Pope