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Company logo: Elliot W. Jacobs, MD, FACS - Diplomate, American Board Of Plastic Surgery

815 Park Avenue New York, NY 10021
212-570-6080

Male Breast Reduction and Insurance

gynecomastia and insurance

If you think dealing with man boobs couldn’t be any more frustrating, perhaps you haven’t contacted your insurance company about coverage yet. We’ve heard all kinds of stories-many of them discouraging-from our New York gynecomastia patients and online in forums like gynecomastia.org. Unfortunately, convincing your carrier to cover even a portion of the cost of male breast reduction surgery can be difficult.

In fact, you should probably consider yourself lucky if arranging for insurance coverage for gynecomastia surgery is difficult. Some insurance companies refuse to cover the procedure at all. As one poster put it on the gynecomastia.org forum, “My insurance company specifically excludes gyne surgery.”

Companies that will consider coverage for male breast reduction often present many hurdles. It’s not unusual for patients to give up pursuing the issue. Men who are up for the challenge usually have to demonstrate at least the following:

  • They have had gynecomastia for a certain period of time
  • There’s no indication of an underlying condition
  • There’s no history of drug use that could contribute
  • The extra tissue is glandular, not fat, and the patient is not overweight
  • The condition is painful, physically and psychologically

If you have insurance that does not automatically refuse coverage for gynecomastia surgery, it is possible to be successful with a claim. Having worked with nearly 2,000 New York gynecomastia patients over many years, our recommendations are as follows:

  • Take good photos of your chest from a variety of angles
  • Make sure you understand your insurance carrier’s requirements
  • Call a representative at the company to discuss anything that’s not clear
  • Review the requirements point by point and determine how to satisfy them
  • Make an appointment with your primary care physician to strategize
  • See an experienced gynecomastia surgeon for additional ammunition

Even when you prepare your case strategically and complete all the steps, your insurance company may deny your request for coverage. Sadly, this isn’t unusual. Don’t be discouraged if this happens-instead, appeal the decision.

Like most plastic surgeons, we don’t accept insurance coverage as payment. But we will gladly advise you and help you plan to make a claim for reimbursement. This is one topic we can cover when you schedule your consultation.

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