Is There Insurance for Gynecomastia Surgery?

by Matt on September 8, 2015

The topic of insurance for gynecomastia surgery is often misunderstood, and all too often people make assumptions without understanding the facts. The prevailing belief is there’s no such thing because surgery for gynecomastia or man boobs is a cosmetic procedure. In truth however, the answer is it depends on the situation and the insurance company and what coverage you have. Under certain circumstances, it is possible to get insurance for man boobs surgery.

Why Do You Need Surgery in the First Place?

Before exploring your insurance options, you need to understand why surgery is necessary. After all there are a lot of alternative treatments available, aren’t there? Well there are a lot of options, but they are not always effective. Let’s take a look at these briefly:

  • Compression vests: these can’t even be considered treatments because all they do is try to conceal your man boobs.
  • Pills: there are a lot of over the counter pills being marketed as natural treatment for man boobs, but the majority are not effective. In fact they could make your condition worse.
  • Creams: the same thing with pills, as many don’t work.
  • Diet and exercise: these can help assuming the cause is excess weight, but if your gynecomastia is due to hormonal imbalance, dieting and workouts won’t be of much help. And there’s really only so much diet and exercise can do if you have a severe case.

To put it simply, male breast surgery works and can be fully customized to meet your needs. Before you go under the knife the doctor will talk to you, explain the process, how long the recovery period is and answer whatever questions you may have. In other words, surgery is the only way you can safely get rid of man boobs without worrying about the side effects. As long as the surgeon is qualified and you follow the instructions, there should be no problem.

Gynecomastia surgery costs and insurance cover

Why Do You Need Gynecomastia Insurance?

The issue is not with the surgical procedure but the cost as the average price of a male breast surgery is $3300 to $3500. This does not include the cost of anesthesia, operating room expenses, surgeon’s fees and other medications you may have to take after the surgery.

The exact amount you have to pay is also going to vary depending on the severity of your condition so before anything else, you should talk to the doctor and get an idea of how much it’s going to cost. Thanks to the internet you will be able to compare the costs without too much difficulty.

So there’s no question that insurance can make a difference, but can you avail of it? Yes, but you to follow these guidelines and check if your case fits. Note: this is only a general guideline as situations can vary.

How to Avail of Male Breast Reduction Surgery Insurance

The first thing you should do is check your insurance coverage because it might be covered. The position of the American Society of Plastic Surgeons is that gynecomastia from grade level 2 and up should be covered by insurance. If it’s not, you may speak with your insurance company and your doctors to see if an arrangement can be worked out.

Needless to say the results will vary from case to case, but just to give you a general idea, but insurance coverage will be given provided:

  • There is pain in the chest area, or on the shoulders, back, upper back and neck
  • You have undergone diagnosis by a qualified physician and certified you are suffering from discomfort and pain
  • Diagnosis confirming there is abnormality and the only recourse is surgery
  • The condition has affected your daily functions and has led to physical and physiological problems
  • You have to present all the paperwork and documents required

There are a lot of other terms you will encounter when trying to get gynecomastia insurance coverage, but what it all comes down to is that the condition must be serious to the point that you are not able to function normally anymore (i.e., if your gynecomastia is life threatening).

If your condition falls under these definitions, you should get a complete diagnosis from your doctor and present the findings to your insurance company. If they find it satisfactory, you can expect some sort of coverage during the procedure. With these conditions it might seem impossible to get insurance for male breast reduction surgery, but that is not necessarily the case.

Male breast reduction cost

What some people don’t realize is that swelling of the breasts could be indicative of a tumor, or it could be due to cirrhosis of the liver or an overactive thyroid. If the problem is medical in nature and requires surgery, you can contact your insurance provider and expect to get coverage.

What it all comes down to is this: before you can receive any insurance for man boobs, you will need to furnish evidence that the surgery is necessary. Depending on your medical condition, further tests may be required by the insurance company before confirming that you’ll be accepted.

What are the Situations When Insurance Won’t be Provided?

Gynecomastia insurance will not be provided if the surgery is for cosmetic reasons only, meaning the condition is not life threatening. There’s no question that for a lot of men, gynecomastia is a serious condition because it affects them emotionally and reduces their self-confidence.

However, medical insurance companies do not see that way: if you read and compare their insurance policies, you will see that they don’t consider psychological problems as an emergency medical situation. Statistics will bear this out, and if you check your insurance coverage or ask about it, you will almost certainly be told that insurance claims are limited to physical abnormalities.

Are You Qualified for Male Breast Reduction Insurance?

To summarize the information, you won’t get insurance coverage if:

  • If your rationale for the surgery is psychological in nature (i.e., boost your self-confidence)
  • There is no medical emergency involved

You will be qualified for insurance if:

  • The fatty tissue is malignant
  • Grade III or Grade IV gynecomastia and 6 months of medical treatment has been tried with no success
  • There is tightness and pain in the chest
  • There is discomfort

Do keep in mind that insurance companies have different policies. While the majority adheres to the policy above, these are general guidelines and there may be differences when it comes to the specifics. Statistics show that many man boobs insurance claims are denied because they file claims owing to their psychological needs. While the emotional effect of gynecomastia is real enough, insurance companies simply do not see it that way, so if you’re going to file a claim make sure that it falls under the provisions given above.

Are There Other Options Available?

If your case is acceptable, then there’s nothing to worry about as the insurance will shoulder some of the costs. If not, there are other companies and services that offer financial solutions in case you want to undergo gynecomastia surgery. There are many surgery financing options available but you need to examine each one and make sure that it’s within your budget and there are no hidden fees.

As has been pointed out earlier, insurance companies will not pay for the surgical procedure unless you prove the condition is life threatening. Because of this you’re going to have to pay for the entire surgical process including all the other miscellaneous fees that may be incurred during the operation.

When looking for financing options and solutions, it’s a good idea to set aside some time to do the research. If you check the Internet, there are many companies that offer interest free payment if you’re able to pay early. But that isn’t always the case so you need to compare the options and make sure that it’s actually better than paying for the operation.

Here are a few other reminders if you’re looking for alternatives to insurance: first, you need to be committed to this because at the end of the day, you need to pay back for the surgery. If you want to go this route, make sure you have the means to pay for the surgery within the time period that you agreed upon.

Also bear in mind the interest rates offered by these companies vary, and they will use different terms and definitions so you’ll need to do some extensive research before you decide which one to go with. Again, make sure that you can pay. With more and more men being open about their gynecomastia problems, it’s hardly surprising that various financing solutions have appeared. More options are always better of course, as this is going to bring the cost down.

Conclusion

As you can see, the whole issue of insurance for gynecomastia surgery is not as simple as it seems. Whereas the assumption is that it’s an automatic, it really depends on the situation, so it’s always a good idea to consider your options before deciding to talk with your insurance provider or seek an alternative financing solution.

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