I wanted to know if there was a way for me to get my insurance to approve my claim for Gyneocomastia Surgery? (photos)
Doctor Answers 7
Gynecomastia is usually a covered benefit.
You will need it worked up to make sure its true gynecomastia
The best way to assess and give true advice would be an in-person exam.
Please see a board-certified plastic surgeon that specializes in aesthetic and restorative breast surgery.
best of luck!
Insurance coverage for male breast reduction surgery
It is very possible to have gyneocomastia surgery (commonly known as male breast reduction ) covered by insurance. This is a legitimate medical condition that many insurance plans will cover.
Most plastic surgeons are considered specialist by insurance companies and therefore if you do no have private PPO insurance the process will entail getting a referral from your primary care doctor. You will then have to see an in- network provider and you will still more than likely need to get authorization from your insurance provider to have the procedure.
In my office for example, I do accept PPO insurance only. After an examination, my office or one similar to mine would contact your insurance company on your behalf and seek authorization to do your surgery. This is done by submitting photos (like the ones you posted here) and taking detailed clinical notes of your physical state and emotional state due to suffering with this condition. Insurance reviews all of these factors when determining if you qualify for surgical coverage of gyneocomastia.
Call the the customer care number on the back of your insurance card to get important health care facts. You will find out if you have HMO ( in-network coverage only, requires referrals) coverage or PPO coverage. You can inquiry if gyneocomastia is a covetable procedure (some PPO plans can have clauses that specifically disallow this procedure as cosmetic). You can also find out what your deductible is. This will be the amount you are responsible for in order to move forward.
From just looking at your photos, it's does seem like you have a case to be covered. Your insurance plan will ultimately determine if you can move forward.
Remember, October is usually annual open enrollment period for many insurance plans. If you are not covered, now is the time to switch.
Please see a doctor in person to get more help.
Best of luck.
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Insurance coverage for gynecomastia
Some insurance carriers require an endocrine workup as well as a letter of medical necessity. Your primary care doctor can address these issues first.
Some carriers go by symptoms and others by grams of breast tissue needed to be removed.
Your photos also show excess skin. To tighten your loose skin, the trade off is longer scars.
Thank you for your question. My best suggestion would be to have a consultation with a Board Certified Plastic Surgeon who will be able to explain to you all of the details of the Gynecomastia procedure and be able to let you know about insurance involvement if any. Stay positive, there are wonderful results with this procedure.
Insurance Coverage and Gynecomastia Surgery
Typically, gynecomastia surgery is not always covered by many insurance or healthcare programs. If it is, it can take some time to acquire approval as criteria can be restrictive. If approved, it's possible to be reimbursed by the insurance company after the surgery. Thus, it may be best to speak to your insurance carrier after you consult with a plastic surgeon. Nevertheless, most plastic surgery offices offer convenient finance plans that allow patients to pay a low monthly payment.
According to the American Society of Plastic Surgeons the average #cost of #gynecomastia surgery can vary widely. #Surgery quotes should include the procedure itself, operating room facilities, anesthesia fees, surgeon’s fees, medical tests, post-surgery garments, prescription medication and other related costs. Costs will also vary with geographic location. Estimated costs can be found here on RealSelf.com, PlasticSurgery.org or Surgery.org.
It is imperative you select a plastic surgeon who is #board-certified and has a great deal of experience with male breast #reduction. Plastic surgeons who have specialized in breast surgery and cosmetic surgery are suitable to perform your procedure. Aside from checking board-certification, it is suggested that you look at before and after photos of the surgeons actual patients, and read patient reviews. Gathering all of this information will help you make a well-informed decision.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.