Blue Cross Blue Shield??

[masterofu]

Does anyone know if BCBS standard plan will cover this? I am even kind of embarrased to call and ask!

[Paa_Paw]

Probably not unless you could produce evidence that the gynecomastia is causing great emotional stress, withdrawal from socialization, poor body image, depression etc. A consultation with a Psychologist May be helpful

The request will be probably initially be rejected. Then you can file an appeal etc.

There have been some recent court cases with favorable decisions.  

Yes, it is doable, but you'll have to do your homework to pull it off.  It will not be easy

[vaio]

Say the gland causes you pain. Say it hurts.  

[Paa_Paw]

If a person does their homework and presents their case well, The demonstrable emotional pain and torment should be sufficient.  Physical pain should not be claimed unless it is present.  

If it can be demonstrated that you are exagerating the pain or claiming pain when none exists; you are sure to be refused the surgery based on the fact that your request was at least partially fraudulent.

[I-Hate-Gyno]

Have anybody recently have blue cross....... cover their cost for surgery. I have them for my insurance provider, but embarrase to call as well.

[jc71]

If you're embarrassed to ask, why not email and ask them.  It's the same as asking the question on these boards.

[vaio]

I have BCBS and they said they would cover it if I could get a note from the Doctor saying it was a medical necessity.

[I-Hate-Gyno]

That sound great. I going to sweet talk my doc., so that I can get that money saving pass . Vaio what happen with your doc? In addition, what makes it considered a medical necessity?

   I-H-G

[vaio]

To tell you the truth, I don't know. I am guessing pain. If it hurts, they got to do something about the pain. It may take a couple of visits to convince them the pain is still there and not going away but they will finally give in sometime.

[jc71]

agree with vaio.  i'd suggest only going the pain route if you truly have pain. Maybe they'll be like aetna and in some cases cover gland removal but not lipo. You'd probably know after a visit to the dr if it's actually medically necessary.

As far as sweet talking your ps, flowers are always nice.  Then again, if you get him a dozen red roses, he may remove something else.  

[I-Hate-Gyno]

           LOL , you are a trip jc71.  I shouldn't have written that word sweet in that sentence, but I could not thing of another word instead. That's a good one though, I going to get you back one day pal. Ouch, I just felt a sudden pain behind my nipple . I'm just practicing for what I going to tell my ps on my next visit.  Thanks mates.
                     I-H-G

[vaio]

If the doctor just brushes you off, make another appointment a month later. Be persistant. Eventually they will have to go gland excision as an option, since it is causing you pain. Than, go to a ps, tell him you want the gynecomastia procedure done with him.

When I asked for the procedure codes so I could speak with the insurance company about paying for it, the woman only gave me the excision code. She said that the secound they see lipo code, they will just throw it out.

Bottom line, if you really want to have insurance pay, you can. You just have to be persistant with it. It may take a few months, but eventually it will get done.

[I-Hate-Gyno]

       Rogar-that vaio, thanks for the info.  They are going to pay for dam-it.

              I-H-G

[Mike_83]

BCBS covered almost everything for my surgery...upwards of 6k.  Didnt' have to ask twice, PS sent in the forms and they were approved. Doesn't hurt to ask

[masterofu]

I think BCBS policy varies from state to state or plan to plan. Which BCBS do you have Mike?

BCBS covered almost everything for my surgery...upwards of 6k.  Didnt' have to ask twice, PS sent in the forms and they were approved. Doesn't hurt to ask