Gynecomastia and Insurance: Two Paths
There’s no shortage of reasons to complain about health insurance these days. But trying to get coverage for gynecomastia surgery just may take you to new pinnacles of frustration. It’s a challenge for our man boob patients in New York, and it’s one of the most vexing aspects of being a gynecomastia specialist as well.
We know that many guys can really use help in paying for male breast reduction. If you’re one of them, check with your insurance company early in your surgical journey to see if they will even consider coverage. Some carriers do not pay for gynecomastia surgery under any circumstances.
If you find your insurance company does cover surgery for some guys, don’t rejoice yet. They will have a long list of requirements for you to fulfill. You’ll need to produce evidence confirming various elements of your condition—you may need to visit more than one other doctor who can support your need for surgery. A counselor who can attest to long term mental anguish may be especially helpful. Visit our post about developing your strategy here.
Here’s a look at how the situation can unfold. Unfortunately, we have seen these scenarios with our New York man boobs patients many times.
Let’s say you jump through every single hoop your company demands. After surgery, which you use your savings for and/or finance, we submit our bill, pathology reports and other supporting documents. After waiting months, you find your company will pay only a fixed amount they have determined, not the actual cost of surgery. And they will apply deductions, refuse to cover certain components of the procedure and so on. In other words, they will whittle down their outlay as much as possible. This is actually the best-case outcome.
In the worst cases, we have known insurance companies who do sometimes cover surgery deny payment even after a patient has followed their requirements to the letter. We are happy to help as much as we can with upfront documentation and appeals, but with these frustrating cases being the norm, you can see why most gynecomastia specialists need payment prior to surgery.
An Alternate View
Going down the insurance road puts you at the mercy of big, profit centered bureaucracies. It’s not exactly a position of empowerment. We sometimes encourage our New York man boobs patients to take on the cost of male breast reduction surgery, if at all possible, and put themselves in control. There are many benefits to doing so—read about them here.
We have seen guys with man boobs in New York come up with creative ways to pay for surgery, and we are happy to share ideas. From starting a savings account with a tax return or bonus from work to asking relatives for help, patients find ways to cover the cost of male breast reduction. We work with a good financing company we refer guys to as well.
Success Does Happen
Finally, be aware that some people have a better chance of success than others. If you live in the U.K., Canada or another country with good, nationalized health insurance, you may be able to get coverage. Guys in the military in the U.S. have also sometimes been successful. Do be aware, however, that with an insurance organization in charge, you may not be able to see the gynecomastia surgeon of your choice, have surgery in the timeframe you prefer and so on.
The first thing we suggest you do, if you’re hoping to convince your insurance company to help, is join gynecomastia.org and browse the forums. Members discuss every facet of moobs you can think of, including insurance. A few people who post have been successful in getting coverage and they may be able to advise you; others have figured out a strategy for paying for surgery themselves.
We would be happy to help as far as we can. We know this challenge well! Send us an email and tell us what’s going on for you.