Is gynecomastia covered by insurance? This question has been asked by a lot of gynecomastia patients. However, most of you might want to hear what the answer actually is. At best, getting coverage is not easy and at worst, it could be excluded.
For insurance companies, covering something like gynecomastia tends to be logical since it is a bona fide medical condition. Thus, regardless of how difficult it is to get coverage; gynecomastia surgery is still covered by certain insurance companies.
However, most insurance companies consider that gynecomastia is an absolutely “cosmetic” procedure, so they tend to hesitate about covering it. However, fortunately, there is still hope. For teens, they might not want to rush into undergoing gynecomastia surgery since teenagers tend to outgrow the condition and so, an insurance company might refuse coverage.
You have to be ready when you are going to your insurance company
If you are suffering from gynecomastia, you are recommended to take the first step and do some research about gynecomastia surgery insurance coverage. Give your insurance company a call or check out your medical insurance policy.
To convince your insurance company with proof that you actually need cosmetic surgery attention for the gynecomastia you are suffering from, you might have to jump through hoops. To get the information that will be needed so that you can file a medical, you can even seek the assistance of a gynecomastia surgeon.
One way of convincing an insurance company to cover your gynecomastia surgery in an early stage is to remind them how it could cost them more money later on. Getting insurance coverage for gynecomastia surgery can be a lot of work; plastic surgeons these days charge a lot of money, so trying is better. Surgery happens to be the most effective way of getting rid of the bulging breast tissue, so will have to do your best to get coverage.
Tips to Seek Gynecomastia Surgery Insurance Coverage
If you are ready to work hard and stay on top of the claims procedure, then be prepared for an adventure. At times, pursuing gynecomastia insurance coverage is made so difficult by the insurance companies that you might it is not worth going through all the hassle.
Is the question, is Gynecomastia covered by insurance, running through your mind, and you are considering asking your insurance company about it? Then, following are a couple of things that you might have to prove:
- You will have to prove that you are suffering from gynecomastia not only physically but psychologically too. For an evaluation, you might be asked to go to a specialist.
- You will have to prove that the condition has been causing you problems for quite some time.
- You will have to prove that you are not suffering from any underlying condition like endocrine or liver disease. The cosmetic surgery will not prove to be effective at getting rid of the gynecomastia permanently if you are. You will also have to prove that you have never used any illicit drugs in the past.
- You will have to prove that your gynecomastia is the actual medical condition, i.e. enlarged breasts in men because of abnormally large mammary glands. If your condition is simply manifestion of being obese or overweight, then your insurance company might not cover it.
Documentation Needed Prior to Gynecomastia Surgery
Although the insurance company might ask you to fulfill additional requirements, yet getting your gynecomastia surgery covered is not impossible. Gynecomastia surgery insurance is something that is definitely worth having and that is why it is worth fighting for it. If the insurance company denies your coverage, then ask them to reconsider rather than getting intimated by their decision.
Other Facts to Keep in Mind
A first request regarding gynecomastia surgery coverage is often automatically turned down by many insurance firms. That is because most people tend to simply forget about it. However, you can end up receiving some coverage if you do not step back and appeal their decision.
In the past, insurance coverage for gynecomastia surgery has been ordered by courts, ruling that gynecomastia is an actual deformity, just like a club foot. So, if your insurance company blatantly refuses to cover your surgery, then you could even appeal to a court of law as well.
So, if you are thinking, is gynecomastia covered by insurance? You will most likely be able to get gynecomastia surgery insurance coverage if you keep the mentioned things in mind when approaching an insurance company.