Can gynecomastia surgery be covered by insurance? Men of any age who are dealing with the discomforts of enlarged breasts may be asking themselves this question.
Male breast reduction surgery is on the rise for males who have worked to lose weight, but find that weight loss alone is not able to shrink the size of their chest as their gynecomastia persists.
Together lets look at some aspects of health insurance and come to a conclusion about whether your procedure can be covered by insurance.
What is gynecomastia?
First off, let’s take a brief look at what this condition is in the first place. Gynecomastia refers to the enlargement of glandular breast tissue in males, which results in the appearance of breasts, sometime referred to as “man boobs”. This condition can affect one or both breasts and may occur at any age.
This excess glandular tissue is caused by an imbalance in the hormones estrogen and testosterone, leading to the proliferation of glandular tissue in the breasts.
While it is a relatively common condition that affects up to 70% of adolescent boys and older men, it can cause significant psychological distress and self-consciousness.
The causes of male breast enlargement vary and can include hormonal changes during puberty, certain medications like anabolic steroids or asthma medication, underlying medical conditions, or lifestyle factors such as obesity or excessive alcohol consumption.
Gynecomastia can start as asymmetrical breast enlargement, a tender or painful lump beneath the nipple area, or with nipple discharge.
While mild cases in gynecomastia patients may resolve on their own over time, severe or persistent cases often require medical evaluation and treatment, including medication or male breast reduction surgery to reduce breast size and restore a more masculine chest contour.
Overall, understanding gynecomastia is crucial for recognizing its symptoms, seeking appropriate medical care, and addressing any associated physical or emotional concerns.
What Factors Influence Insurance Coverage?
As we all know, getting a health insurance company to provide insurance coverage for any cosmetic operation such as rhinoplasty or a blepharoplasty can be tricky. Insurance companies typically require evidence that gynecomastia causes physical discomfort, functional impairment, or psychological distress to classify it as medically necessary.
Here are a few other factors that will be looked at by insurance providers in regards to your gynecomastia procedure coverage:
- Documentation: Comprehensive medical records, including documentation of symptoms, diagnostic medical tests, and previous treatments, may be necessary to support the medical necessity of gyno surgery.
- Policy coverage: Health insurance policies vary by insurance provider regarding coverage for gynecomastia treatment of enlarged male breasts. An insurance policy may explicitly exclude coverage for cosmetic plastic surgeries, while others may offer coverage for medically necessary treatments.
- Deductibles and copayments: Patients may be responsible for meeting deductibles and copayments outlined in their insurance plans before receiving coverage for gynecomastia surgical treatment.
- In-network providers: Health insurance plans may be limited to treatments provided by in-network healthcare providers. Patients should verify the network status of their healthcare providers to ensure their eligibility to be covered by their health insurance company.
- Appeals process: If insurance coverage is initially denied, patients have the option to appeal the decision. This may involve providing additional documentation or seeking assistance from healthcare providers to support the appeal.
How to Get Gynecomastia Surgery Covered by Insurance?
To qualify for insurance coverage for gynecomastia surgery, you will usually need comprehensive medical documentation that demonstrates the medical necessity of the procedure.
This evaluation should include the following criteria: a physical examination to assess the extent of gynecomastia, documentation of any associated symptoms (such as pain or tenderness), and determination of the impact on your physical and psychological well-being.
Diagnostic tests may also be needed to show results, such as hormone level measurements (testosterone, estrogen, etc.), imaging studies (ultrasound, MRI, etc.), or biopsy results, to confirm the diagnosis of gynecomastia and rule out underlying medical conditions.
A comprehensive medical history, including any previous treatments for gynecomastia (such as medications or hormone therapy), as well as a history of related medical conditions or medications, should be documented.
Before-and-after photographs of your chest can provide helpful visual evidence of the extent of gynecomastia and the impact of treatment. These photographs should be taken from multiple angles and clearly show the appearance of the chest before and after treatment.
A detailed treatment plan will be requested by many providers to see an outline of the proposed surgical approach, anticipated outcomes, and expected benefits should be documented. This plan should be supported by evidence-based guidelines and tailored to your individual needs and goals.
How Much Does Gynecomastia Surgery Cost?
Gynecomastia surgery costs will vary based on the extent of the plastic surgery that is necessary to remove your excess breast tissue. Your plastic surgeons experience and skill will also factor into the cost of gynecomastia surgery. Here is a brief list of what gynecomastia surgery costs will include:
- Surgeon’s Fee
- Operating Room Facilities
- Local or General Anesthesia Fees
- Cost of Medical Tests
- Prescription Medication
- Post Surgery Compression Garments
- Geographical Location
Consult your physician for a copy of the American Society of Plastic Surgeons’ position paper, which outlines recommended criteria for reconstructive gynecomastia cases. Submitting this document to your insurer can support your claim for coverage.
Gynecomastia Surgery FAQ’s
Can Gynecomastia be medically necessary?
Surgical treatment for gynecomastia, whether unilateral or bilateral, may be deemed medically necessary for individuals diagnosed with Klinefelter’s syndrome and grade III or higher gynecomastia upon physical examination.
Are there gynecomastia surgery financing plans?
As gynecomastia surgery is typically categorized as a cosmetic procedure, it’s difficult to get health insurance to cover the expenses. Options such as cosmetic surgery loans, cash payments, credit cards, and installment plans can be utilized to finance the surgery.
How to afford gynecomastia surgery?
Patients are encouraged to explore financing options available through their plastic surgeon’s office.
Many practices partner with specialized medical financing companies like CareCredit, offering low-interest rate loans customized for medical procedures.
Why is gynecomastia so expensive?
Certain patients may only need fat removal, while others may require a combination of fat and breast tissue removal.
The complexity of the procedure influences many plastic surgeons fee and the total cost. The surgical location plays a role in determining the price.
Can I live with gynecomastia forever?
In many cases, gynecomastia can by helped with minimal intervention and a low risk of lasting complications.
This noncancerous condition is an excess of glandular breast tissue in males, often affecting both sides but occasionally occurring unilaterally. Hormonal fluctuations commonly underlie its development.
Schedule Your Gynecomastia Consultation Appointment
Consulting with Dr. Galanis at Galanis Plastic Surgery in Beverly Hills is a great opportunity to learn everything you need to know about Gynecomastia surgery from a true professional. Set up your appointment today and get back on the road to feeling better about yourself today.
