Insurance & Gynecomastia

[jt1234]

I recently had been denied from having the procedure covered by my Insurance.  I am going to appeal the decision and I am in need of advice to anyone that has gotten the procedure covered through insurance.  Also, I am desperate for articles that support the surgical procedure especially stating the medical necessity. Please include comments, links, etc...I appreciate everyone's advice

THANKS

[vaio]

say it causes you pain...i think the medical term for it is mastalgia or something like that.

[BigApple]

Check this out:

New York Daily News - http://www.nydailynews.com
 
Hit insurer for teen's breast op  
BY HELEN PETERSON  
DAILY NEWS STAFF WRITER  
Wednesday, December 1st, 2004  

Breast reduction surgery for an 18-year-old man wasn't just cosmetic, it was a medical necessity, a Manhattan judge ruled.  

The decision came in a lawsuit filed by the Long Island teenager's father, who sued his health insurer, GHI, for refusing to pay for the surgery.  

Small Claims Court Judge Barbara Jaffe said the teen, who suffers from a hormonal imbalance, was robbed of a normal life by his condition.  

"In order to avoid the great embarrassment and suffering he endured when ridiculed by his peers, [the teen] never swam, went to the beach or engaged in any activities which exposed his chest to view," Jaffe wrote in her decision, made public yesterday.  

The teen's father, whose name is being withheld by the Daily News, represented himself in the case, even though he's not a lawyer. "We just felt that this was a case that should be heard and I was not going to give up," he said.  

GHI argued that the surgery was cosmetic and elective and not covered by insurance. The insurance giant said it will appeal.  

The dad said his son had the $7,500 surgery in July and was thrilled with the results.  

"The kid's emotional state went from zero to 100. It was a tremendous attitude change for him," the teen's father told The News. "If it cost me $100,000, I would have done it."  

He said his son's condition, known as bilateral gynecomastia, was caused by a hormone imbalance.  

After his claim was rejected, he filed a $5,000 lawsuit in Small Claims Court, and presented a case, including affidavits from doctors who said the teen's breasts were "inhibiting his psychosocial development."  

[tnel00son]

yeah, these damn insurance companies, all they want is your money, they dont care about anything or anyone..

[STILLgotIT]

BigApple, that was a rad story. Thanks for posting it!

[Grandpa Bambu]

Also, I am desperate for articles that support the surgical procedure especially stating the medical necessity.

IMO, Gyne removal is not a 'medical' necessity unless you have breast cancer. Guys can 'function' normally with Gyne. I did for 31 years. Yes, I shied away from swimming, most sports, public change rooms etc... but that was my choice. However, I know from my own experieces, that Gyne causes much psychological pain/discomfort and a great deal of stress. Insurance companies need to recognize how much pain Gyne sufferers are in and provide some sort of medical funding to have it removed, the same as some one getting a hip replacement or a heart by-pass etc.

IMO, Gyne removal is a 'Psychological' necessity. Not a medical necessity.  

John.

[vaio]

I agree with Bambu 100%

[Paa_Paw]

bambu is correct,  you may have to enlist the support of a psychologist for your appeal.  

The issues are psychological and emotional.  Insurance companies usually deny this type of surgery initially.  You can have a successful appeal, but it will require some homework on your part.

Good Luck.