Insurance Coverage for Gynecomastia Surgery

insurance coverage and gynecomastia

Mention insurance and gynecomastia in the same sentence, and both surgeons and patients with man boobs in New York may roll their eyes. Medical insurance companies are not held in high regard in general by most people in the U.S.—one reason being that when they find reasons to deny coverage they seem to leap at them.

Gynecomastia surgery is deemed “cosmetic” and therefore not necessary by many companies, and the majority won’t cover it. Even those who do occasionally pay part of the bill make patients jump through many hoops.

That said, if you’re planning man boob surgery in New York and you’d like to try for coverage, we are here to support you. These are the steps you should be prepared to take:

    1) Contact your provider. There are several things to be looking for:

    • Assuming you hear that the company may cover surgery, you need to know what the criteria are. For instance, the company may say they’ll pay for a portion of the procedure if you can demonstrate there’s no underlying cause (such as an endocrine issue, drugs linked to gynecomastia and so on), if you’re at a normal weight, if your man boobs cause you to restrict daily activities, if…if…if.

    • In short, they want you to prove that surgery is a medical necessity. Write down everything you hear and ask to be pointed to a site or document that details the considerations. Find out if you should get letters or written evaluations from other professionals and if you need to submit photos.

    2) Schedule an appointment to discuss your gynecomastia with us in New York. Let us know you are hoping to get coverage from your insurance company, and we’ll do all we can to help. We can write a letter asking for pre-authorization and we’ll create supporting documents such as a surgical plan. In the best possible cases, pre-authorization will be granted within a few weeks.

    3) Be prepared to appeal. Unfortunately, denial is all too common when it comes to insurance coverage for gynecomastia surgery. We know of a few people who have battled back successfully with additional information about the psychological impact of man boobs—if you have seen a counselor and discussed the issue, ask for their support. If you’re young and a teacher can attest to challenges you’ve had in school, that could be helpful too (your condition needs to be stable for two years if you’re an adolescent).

    4) Arrange payment up front. We know how devastating a case of man boobs can be for a guy, and we also know that well-performed surgery can be life changing. We hope you will be able to schedule your procedure whether or not your insurance company sees the light. Most patients who are highly motivated to have man boob surgery find a way to do it through and perhaps a loan. (More on how to finance man boob surgery here.) Some guys are comfortable asking family members to help, and today some even launch an online fundraising campaign.

Like just about every other plastic surgery practice we know, we can’t accept insurance coverage as payment. The uncertainties are just too great. Most won’t cover the procedure, some will provide partial coverage weeks or months down the road. Worst of all, some say they will cover part of the surgery at first, then deny a claim later.

What we will do is apply our thirty years of experience in trying to help. This includes billing your company after surgery, in which case payment will go directly to you. Our front office folks are adept at processing claims and we will do our best.

If you discover your insurance company will not help you with payment for surgery, there are benefits to going it alone. It’s true! We can think of several reasons it can be a relief to reject the notion of involving your insurance company—read about them here.

Whatever your situation may be, we would love to hear from you and discuss your options for gynecomastia surgery in New York. Fill out our short contact form and tell us your story.

Photo by Tim Gouw from Pexels

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