Insurance coverage?

[P1TT]

Hi, Will my insurance really cover the procedure if I have documentation from a therapist and doctor? I called two local plastic surgeons and they said they had many patients that were covered as long as they had documentation from doctors/therapist for emotional/psychological reasons.

[Dr. Elliot Jacobs]

The answer to your question lies with your own insurance company.  And within every insurance company, there are many different types of policies with different coverages.

Best to first determine exactly what your policy is with your company.  Then go online and read all the criteria that the company posts about possible coverage for gynecomastia surgery.  Then go about trying to fulfill those criteria.  One thing, though, virtually no company will provide coverage due to emotional distress or psychological reasons -- trying to get approval in this regard would be a waste of time.

And finally, understand that even if you fulfill the required  criteria, the insurance company has the ultimate decision makiing power.  Remember, they are not on your side -- they are on the side of making money for their owners.

Dr Jacobs

[Dr. Schuster]

I have only had a few patients in which the surgery was covered by insurance. They either had a brain tumor (Prolactinoma) or a direct result of a medication. general psycological well being won't cut it unles they have a special self insured executive plan - if that.

[Litlriki]

Insurance coverage is rare, even though most will say they cover the procedure.  That means that in some rare circumstances, they may very well cover it, but you will jump through a million hoops and even then they may not pay the surgeon (based on a true story!) 

[DrPensler]

Short answer,NO. Even for patients with Klinefelter's its tough today.