Cysts on Chest - Covered By Insurance?

Question

I Have Like 8 Med/lg Cysts Running Down the Middle of my Chest and Like 30 Ingrown Hairs that need to be removed by a dermatologists. I want my insurance to pay for it. They have been a source of embarrassment for me my whole life and I know my husband is turned off by them but he would never say anything. What would be a valid reason to get the dermatologists to remove them and have my ins pick up the tab. I've gone to dermatologist before but they just plain didn't want to remove them. Breast cancer does run in my family. Thank you ~

Ron Shelton, MD · Answer

Don't squeeze your cysts trying to get the content out. That would only serve to increase the chance of the cyst wall's rupture which can create a significant amount of swelling. You should be on the alert for pain, any change in shape or color of the cysts, or if the cyst starts to drain. those changes could prompt a need for the doctor to remove them.

Adil Usman, MD · Answer

Medical insurance covers things that are deemed medically necessary. What is medically necessary may differ between different insurance companies. If something is causing symptoms--pain, itch, burn etc., looks suspicious for cancer or is an infection, it is usually covered.

Sandy Martin, MD (retired) · Answer

This is a question I frequently get asked.  My own experience with various insurers is that if cysts are not abscessed and infected, they are considered cosmetic and not covered.  Of course, if a patient has a lesion that the dermatologist wants to biopsy to rule out cancer, that is a different issue.  The idea or concept of "cosmetic" according to the insurance industry may not match the patient's.  So, by "cosmetic", I think it is more appropriate to use the phrase "medically necessary."

	Remember, insurance is a contract that you purchased.  Inevitably you shopped for the best price (or perhaps your employer did this on your behalf), and in order to give you that best price, the insurance company had to put a governor on what it would allow to be done.  This is where the "medically necessary" phrase comes to light.

	Because a patient has a bump that they are embarrassed by, does not make it medically necessary.  After all, a person might be embarassed by small breasts but they instinctively know that to augment them would not be a medically necessary...or covered procedure.

	I'm sure this is not what you wanted to hear, but I hope this explanation helps.

Cysts on Chest - Covered By Insurance?

Answers (3)