Insurance

[VHDude78]

It seems like there may be a good posibility that I may need surgery. I'm seeing my endo specailist in a few weeks to discuss my mammogram and blood test results. Both came up fine. Radiologist told me I had nothing to worry about. I told my primary doctor that I was scared my insurance wouldn't cover it if I needed surgery. He just laughed and said, "Don't worry..we have ways around that. If it's recommended by a specialist..they'll do it." I was so relieved. I've been reading around on these forums and there is a lot of negative feedback on insurance covering the surgery. I know my doctor told me I didn't have to worry..but who knows. What are the chances of my insurance covering?

[xelnaga13]

Most guys I talk to that were denied did not complete all the necessary steps to qualify for insurance coverage. Visiting a surgeon and getting a letter is only one small part of what needs to be done. My insurance company required the following:

1. letter from primary stating that I was in good health and not on any medication that causes gyno
2. Letter from endo stating that my hormones were stable
3. Ultra sound showing actual breast tissue
4. Letter from surgeon stating that I was in constant PAIN and surgery is medically necessary

Your surgeon will bundle these items and send them as a package to the insurance company. The trick is to put the insurance company in a position where they legally have to cover your surgery.

Make sure your surgeon is competent in the process of getting insurance coverage. My first surgeon knew very little about the process sent off a 5 sentence letter and boom DENIED. My 2nd surgeon bundled everything , and sent a passionate letter about my medical plight.

[VHDude78]

Thanks for the feedback xelnaga13! I read a document from my insurance company regarding the surgery. It states if it is indeed obvious breast tissue and it's causing pain it will be done. It does actually hurt from time to time and I made my primary doctor aware. So I think I'm in the clear...

[xelnaga13]

Don't forget to report back on your outcome.