Can Gynecomastia Surgery Be Covered by Insurance? Yes, But Here’s What You Need to Know

Advertisement
Advertisement

If you’re looking into Gynecomastia Surgery, one of the first things you’ll want to know is If you’re looking into Gynecomastia Surgery, one of the first things you’ll want to know is can Gynecomastia surgery be covered by insurance? Unfortunately, this isn’t a question that has an easy answer the answer depends on your situation and what type of insurance you have. While some insurance companies cover the cost of Gynecomastia Surgery and related treatments, others don’t cover any cosmetic surgeries at all, leaving the full cost of your procedure up to you to pay out-of-pocket.

Recommended: Does health insurance cover fibroid removal? All you need to know

Quick Definitions

There are several different types of surgery that can correct gynecomastia. The kind your surgeon recommends will depend on various factors, including whether you want larger or smaller breasts and how severe your condition is. Some common types of gynecomastia surgery include Liposuction: This cosmetic procedure removes fat deposits to give you smaller and more symmetrical breasts.

Nipple reduction: With moderate-to-severe Gynecomastia, one or both nipples may appear large because they are attached to enlarged breast tissue. This surgery trims down their size but leaves them erectable which means you can still wear your favourite man cleavage T-shirts afterwards.
Many patients pay for surgeries using Health Savings Accounts (HSAs) or Flexible Spending Accounts (FSAs). These accounts allow you to set aside money pre-tax and then use it on eligible medical expenses. So if you have a high deductible health plan (HDHP), you can use your HSA or FSA funds to cover gynecomastia surgery costs.

If you don’t have an HSA or FSA account, other ways to cover Gynecomastia surgery costs. For example, some surgeons offer financing options that allow you to make monthly payments until your balance is paid off. And suppose you’re a member of a group plan at work. In that case, many employers will reimburse their employees for gynecomastia surgery costs as long as they were prescribed by a doctor and performed following medical guidelines.

When Insurance Will Cover Gynecomastia Surgery

According to insurance company Blue Cross Blue Shield of Illinois, medical coverage will pay for Gynecomastia surgery only if it is deemed medically necessary. Also known as male breast reduction or man boob reduction surgery, gynecomastia occurs when a man has abnormally large breasts. The condition is often caused by steroids and typically affects men between their teens and early 20s; it rarely occurs in older adults.

Many patients who undergo Gynecomastia surgery are forced to pay out-of-pocket until their insurance agrees that there is a medical need for treatment. An incorrect diagnosis of gynecomastia can lead to overpaying for unnecessary treatment. In fact, according to ABC News Health, doctors have been found guilty of performing needless surgeries on healthy people so that they could collect insurance money. When considering whether or not your insurance plan covers your surgery, make sure you discuss all possible outcomes with your doctor before scheduling any procedures. If you have any questions about how much gynecomastia surgery costs or what type of procedure would be best for you.


While Blue Cross Blue Shield of Illinois does not cover surgical treatments for Gynecomastia, men diagnosed with abnormally large breasts can still have their condition surgically treated if they have a health plan from another provider. To avoid paying out-of-pocket for unnecessary gynecomastia surgery, talk with your primary care physician and choose a specialist carefully. Get an unbiased second opinion and always follow up with your insurance company before scheduling any procedures; otherwise, you could pay hundreds or even thousands of dollars that could have been avoided if you just knew how much gynecomastia surgery costs.

Recommended: Does health insurance cover fibroid removal? All you need to know

How Much Does it Cost, And How Long Does it Take?

The cost of Gynecomastia surgery is a big factor for most men. To give you an idea of gynecomastia surgery cost and how long it takes, let’s look at five different male breast reduction surgeons in three cities around the United States: New York City, Denver and San Francisco. On average, male breast reduction surgery will cost $4100 plus travel expenses for local procedures and $13000 for out-of-town procedures.

It typically takes two weeks to schedule a consultation and another week or two before your procedure date. However, most men can expect their recovery time to last between four and six weeks post-procedure. This means that, on average, you should plan on spending about one month total with your doctor after your surgery date. All things considered, that’s not too bad!

Tips on How to Get Insurance Coverage for Gynecomastia Surgery


If you decide surgery is your best option. Suppose you want insurance coverage for it (and keep in mind most surgeons offer a discount for paying out of pocket). In that case, there are several steps you can take to ensure that your policy will cover it.

First, make sure you see a surgeon with experience in gynecomastia surgery; most cosmetic surgeons do at least some work, so ask around or search online for a board-certified plastic surgeon near you with extensive experience in Gynecomastia. A surgeon should also be able to provide photos of patients they’ve treated, which should give you an idea of their skill level.

Advertisement

In addition, have realistic expectations about what kind of results you’ll get from surgery. In other words, if you’re looking to go from man boobs to six-pack abs, understand that it won’t happen overnight. Even after gynecomastia surgery, most men still have small amounts of breast tissue left behind -like when women undergo breast reduction- and typically need more than one procedure to achieve their desired look.

Be clear with your surgeon about what you hope to achieve during your first procedure so they can better assess whether additional functions might be necessary down the road. Once you find a qualified surgeon, ask how many procedures they’ve performed and how many patients have required follow-up surgeries.


Finally, before scheduling your surgery, talk to your insurance company directly about whether or not gynecomastia surgery is covered under your plan. At the same time, many insurers don’t cover these surgeries due to a lack of evidence proving that they improve quality of life. Others may require specific criteria to be met before approving coverage. Ensure you know those criteria ahead of time so there aren’t any surprises once you submit your claim.

The American Society of Plastic Surgeons says that gynecomastia surgery is considered medically necessary in cases where a patient has severe chest pain caused by enlarged breasts, skin rashes caused by large breasts rubbing against clothing, breathing problems related to large breasts pressing on the lungs and heartburn caused by large breasts pressing on stomach acids. The group says that doctors should consider non-surgical treatments as a first line of defence for milder cases of gynecomastia.

These include weight loss and lifestyle changes such as avoiding alcohol consumption and smoking cigarettes. However, ASPS notes that only 15 per cent of people diagnosed with mild to moderate gynecomastia seek treatment because embarrassment keeps them from doing so.

Final Thoughts on Can Gynecomastia Surgery Be Covered by Insurance?


If you have Gynecomastia and want it corrected with surgery (and if your insurance doesn’t pay for it), you should do your homework. Meet with a board-certified plastic surgeon specializing in gynecomastia surgery, explain your situation and ask questions about how likely you are to get coverage. Suppose a provider tells you not to worry about insurance because it won’t be an issue or says something like don’t tell them what we are doing until after we do it; walk away immediately.

Those are red flags find another provider. Also, keep in mind that most insurance companies require multiple opinions before they will cover any procedure. Don’t be afraid to seek out additional opinions from board-certified plastic surgeons who specialize in Gynecomastia surgery as part of your research on finding a great surgeon for you.

While there is no guarantee that any particular surgeon will ultimately receive approval from your insurance company, using these tips can greatly increase your chances of getting covered and moving forward with correcting gynecomastia once and for all!


So when you think about requesting insurance coverage for gynecomastia surgery, there is quite a bit involved. For instance, whether your health plan has contracted with providers for specific procedures, treatment areas, or even certain diagnoses can be based solely on their contracted rates. In other words, just because an outside organization declares some condition covered doesn’t mean that everyone gets paid fairly.

Just having enough medical coding information isn’t always enough to ensure proper payment and lead to better overall results – so if anyone tells you differently and asks for money upfront – run away fast…or find another doctor!
Some insurance companies also require patients’ complete preauthorization paperwork proving they have tried other avenues before seeking surgical correction through their plan.

Don't miss any update.

Enter your email to receive the exact Insurance tips i practice!

Subscribe
Notify of
guest
0 Comments
Inline Feedbacks
View all comments