Gynecomastia, Insurance and Fairness
Life isn’t fair. We all know it, and as we mature, most of us figure out how to make peace with it. You can probably come up with some experiences that helped you with this lesson: that time you lost a spelling bee to a kid who handled a word much easier than yours, the day you were passed over for a promotion you truly deserved, or when you lost a loved one much too early in life.
Still, it can be difficult to come to grips with personal situations that seem to make no sense at all. That can be the case for guys with gynecomastia who really need their insurance company’s help to cover the cost of male breast reduction surgery. Gynecomastia is a problem with a proven solution, and when it just doesn’t work for a prospective patient, the frustration can be intense.
We read about this over and over on gynecomastia.org, and we hear it in our New York gynecomastia consultation room. Sometimes men’s feelings evolve along a similar path. A guy may experience the first flash of injustice when he realizes that women who are interested in breast reduction can be successful in getting insurance coverage because their breasts can cause physical problems. Most guys can’t claim their moobs trigger physical problems, but they are all too aware of other issues man boobs cause.
Next, thoughts may turn toward guys who are able to get coverage for a mastectomy as part of their female-to-male transition. Ordinary men with gynecomastia can feel—and justifiably so—that if insurance companies can be persuaded to cover surgery for the sake of psychological health, this reasoning should apply to them as well as to transgender individuals.
Eventually, most men come to accept today’s reality about insurance and gynecomastia, if not agree with it. One member of gynecomastia.org perhaps said it best:
And just to be clear: in no way do I feel that transgenders and women suffering from too large breasts deserve their surgery less; But I do believe men like me, who have breasts and cannot come to terms with it (I tried…) deserve it just as much.
As patients learn from the experiences of others, they usually spend less time railing about what’s fair and more time looking ahead. Some decide to try approaching their insurance carrier with a case based on psychological considerations. We have seen this work once in a while, when most of the following factors line up:
• The patient suffers emotional issues such as depression related to man boobs
• The patient’s health is affected as he refrains from physical activity
• The case is supported by evidence from doctors and/or psychologists
• The insurance company has a progressive view on gynecomastia
One frequent contributor to gynecomastia.org had some advice for guys wanting to go this route. He said that while it’s important to convince the insurance company that the psychological suffering is real (and costs them money), guys should take care not to come across as mentally unstable.
When we meet a patient in New York with gynecomastia and insurance woes, we do everything we can to help. We can become one of the supporting doctors if the patient wants to make and possibly appeal a case. We can offer suggestions based on our three decades of treating guys with man boobs. Due to the uncertainties inherent in working with insurance companies we can’t accept insurance as payment, but our staff can help submit a claim.
We can also work with you when it comes to financing gynecomastia surgery. We understand that most guys can’t pay for male breast reduction without planning for it, and we can discuss various strategies.
We get it—nothing about gynecomastia is fair, including insurance. But we promise to be fair with you. If your goals are to understand your condition thoroughly, evaluate your surgical options objectively, figure out how to cover the cost, then get on with life, that’s a plan we can get behind. Tell us about your situation and we will get back to you.