Will insurance typically cover gynecomastia surgery if it's due to an underlying medical condition like hypogonadism?

Question

I was diagnosed with hypogonadism 4 years ago (T level 95ng/ml). No pituitary tumor. I was Rx'ed Testim but decided not to take it because I was worried about losing my hair plus read that T replacement therapy can cause gynecamastia to get worse. I never went back for a follow up appt. Now I do feel worse and gynecamastia is also worse. I decided to follow up and hopefully be able to have the surgery if insurance will cover it, and start taking testosterone. Should insurance cover this?

Jed H. Horowitz, MD, FACS · Answer

According to official statistics, 36% of adult young men and 57% of older #adult men in the United States have this medical condition in one of the four grades. About 200,000 to 3 million cases of #gynecomastia are being reported every single year. So if you have #breast #enlargement and you feel you're an exception, please understand that 1 in 3 young adult #men and 1 in 2 older adult men are just like you and have breast enlargement.

There are three types of surgical treatment options available that treat gynecomastia. Your board-certified plastic surgeon will recommend the type best suited for you. The most important decision to be made before performing any surgical procedure is determining whether you are an ideal candidate. Weight, and more specifically body mass index (BMI), need to be considered when deciding. Consulting with a board-certified plastic surgeon is highly suggested in order to determine if you are a surgery candidate and what treatments are best for you.

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. 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.

J. Jason Wendel, MD, FACS · Answer

Thank you for your
question.Insurance may or may not cover gynecomastia surgery in your situation.  It depends on if it is a covered benefit under your plan and other factors.  Usually a precertification and predetermination is necessary.

To be sure, see
two or more board-certified plastic surgeons in your area for a full and
complete evaluation to make sure you are a good candidate and that it is safe
for you to have surgery.

I hope this helps.

Kenneth Hughes, MD · Answer

Insurance may cover the surgery, but policies differ a great deal and this can be hard to predict.Kenneth Hughes, MDLos Angeles, CA

Gregory T. Lynam, MD · Answer

The key is what your particular insurance is going to cover, all policies differ in the scope of coverage. It most likely will require a current visit with an endocrine doctor. This is important for insurance approval. Good Luck!

Ronald Levine, MD · Answer

I highly doubt insurance would cover it because it's an aesthetic condition rather than health related. The surgery may not be effective as well, since the condition often resolves itself (if there is an excess of breast tissue) when you resolve the underlying medical condition causing it. However, you can still try.

Will insurance typically cover gynecomastia surgery if it's due to an underlying medical condition like hypogonadism?

Answers (7)

Answer: Surgery question

Answer: Surgery question

Answer: Insurance coverage

Answer: Insurance coverage

Recommended reading

Everything you need to know about Gynecomastia Surgery

Our mission is to create a world where every investment in modern beauty is Worth It.

Will insurance typically cover gynecomastia surgery if it's due to an underlying medical condition like hypogonadism?

Answers (7)

Answer: Surgery question

Answer: Surgery question

Answer: Insurance coverage

Answer: Insurance coverage

Browse related questions

Recommended reading

Everything you need to know about Gynecomastia Surgery

Our mission is to create a world where every investment in modern beauty is Worth It.