How to get United Health Care Choice Plus to cover gynecomastia surgery?

Question

I have gynecomastia since i could even remember. It causes back pain and so much discomfort. I also get really bad rashes on my nipples to the point where clear yellowish liquid comes out. I lost weight and gynecomastia is still an issue for me and if anything got worse. I already have to pay enough to correct the extra skin on my stomach and feel this is a medical necessity and they should pay at least a portion. How do I get insurance to cover? Is that my plastic surgeons job?

Kenneth Hughes, MD · Answer

Go to the uhcprovider web site to determine the likelihood of UHC covering any part of your gynecomastia surgery. In my experience, most medical insurance providers consider it non life threatening and do not cover. In most cases completing the large amount of paperwork for determining coverage is not worth the insignificant amount provided by the insurance if they do cover a portion. It is not your surgeon's job to complete the paperwork.Kenneth Hughes, MD, Board Certified Plastic Surgeon
Los Angeles, CA

Miguel Delgado, MD · Answer

Unfortunately insurance companies consider gynecomastia to be a cosmetic procedure. There have been very few cases that actually got approval. Be sure to see a board certified plastic surgeon that specializes in gynecomastia. when describing your symptoms ask your surgeon to submit for insurance coverage, you will most likely get denied, but then you can request an appeal. In most cases when an appeal is requested the insurance company will have a doctor contact your doctor to discuss your case. Don't count on it, but it might be worth a shot. Good luck.

Chad Robbins, MD · Answer

Hello and thank you for your question.    I don't beleive insurance companies pay for correction of gynecomastia, it isn't medically necessary.  You can call UHC and ask .

Robert L. Kraft, MD, FACS · Answer

Years ago, insurance criteria were looser. About 20 years ago, they started to designate gynecomastia surgery as cosmetic with the only exception initially for men whose mothers had had breast cancer. This was further tightened to allow surgery only if an actual mass was present. If you have discharge or rashes, you should be seen by an appropriate specialist such as an endocrinologist or dermatologist.  Insurance rules are posted on the United website where you can read them.  Gynecomastia is not linked to back pain as would be macromastia in women. As a plastic surgeon, I will attempt to preauthorize anything that is a legitimately covered service but, frankly, cannot devote time and effort to cases that do not at all meet criteria. This compromises my integrity and credibility as to covered services.Best wishes.

How to get United Health Care Choice Plus to cover gynecomastia surgery?

Answers (4)