How To Get Gynecomastia Surgery Covered By Insurance [Expert Answer To Reddit Question]


How to get gynecomastia surgery covered by insurance? a popular question on reddit but here is the answer.

Using your health insurance to pay for gynecomastia surgery can be tricky, especially if you’re wondering about ways to get it covered in the first place.

Gynecomastia surgery can range from $5,000-$8,000 or more, and the cost alone might be enough to deter people from pursuing this procedure at all.

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The good news is that there are many tips you can use to get your gynecomastia surgery covered by insurance, which will make the entire process much easier on you and your family.

How to Get Gynecomastia Surgery Covered By Insurance

  1. Know your policy. Check with your insurance company to see if they cover gynecomastia surgery.
  2. Get a referral from your doctor. Many insurance companies require a referral from a doctor before they will cover surgery.
  3. Do your research. Shop around for quotes from different surgeons.
  4. Find a surgeon who is in-network with your insurance company. In-network surgeons have agreed to accept the insurance company’s rates and terms.
  5. Ask about pre-authorization. Some insurance companies require pre-authorization for surgery, which means that the company must approve the surgery before it will be covered.
  6. Follow up with your insurance company after the surgery to make sure they received all the necessary documentation and have processed the claim correctly.
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Let’s dive in a little bit;

1) Use the internet

The internet is a great resource for finding information about gynecomastia surgery. You can learn about the different types of surgery, what to expect during and after the procedure, and how to find a surgeon who is covered by your insurance.

Keep in mind that this website doesn’t provide medical advice, so if you’re unsure or want more information on getting insurance coverage for gynecomastia surgery, contact your doctor.

2) Know the medical terms

The first step is to know the medical terms associated with your condition. When you have the correct terminology, you can start to look into whether or not your insurance will cover the surgery.

Here are a few key terms to get you started:

  • Gynecomastia: This is the medical term for enlarged breasts in men. It can be caused by a hormonal imbalance, certain medications, or obesity.
  • Mastectomy: This is the surgical removal of breast tissue. It is often used to treat breast cancer, but can also be used for gynecomastia.
  • Insurance: This is a type of coverage that helps pay for medical expenses.

3) Show them evidence

If you’re looking to get your gynecomastia surgery covered by insurance, you’ll need to show them evidence that the surgery is medically necessary.

Here are 7 tips to help you do just that:

  1. Get a referral from your doctor.
  2. Make sure your surgeon is board certified.
  3. Collect before and after photos.
  4. Keep all documentation from your surgeon, including the medical necessity letter.
  5. Stay in touch with your insurance company throughout the process.
  6. Keep detailed records of all correspondence with your insurance company.
  7. Be prepared to appeal if your claim is denied.

4) Do it at a hospital instead of a clinic

Many insurance companies will not cover gynecomastia surgery if it is done at a clinic. This is because they consider it to be a cosmetic procedure.

However, if you have the surgery done at a hospital, your insurance is more likely to cover it.

Here are some tips to help you get your surgery covered

  1. Make sure that the doctor who performs the surgery has privileges at a nearby hospital
  2. Be sure to mention that you want your insurance company to pay for your treatment
  3. Check with them about their in-network benefits and whether or not they would cover this type of surgery
  4. Ask how much of the cost would be paid for by insurance and how much would be paid out-of-pocket
  5. If you want coverage for physical therapy post-surgery, ask about that as well before making an appointment
  6. If possible, try going to an employer sponsored health plan
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5) Get clear diagnosis from 2 sources

In order to get insurance to cover your surgery, you’ll need a clear diagnosis from two sources. The first source should be your primary care physician.

They will likely refer you to a specialist for further testing and diagnosis. Be sure to get all the tests and documentation from the specialist so that you can submit it to your insurance company.

If they refuse coverage, go back to your doctor and have them send in another referral. If they still refuse coverage after that, call them up and ask why they’re refusing it if the diagnosis is as such.

In some cases, insurers require lab work or other tests before approving gynecomastia surgery. Ask what these are when you call them up so you know what to expect when going in for the appointment.

6) Find out what caused it

One of the first things you’ll need to do is find out what caused your gynecomastia. Was it a medication you were taking? A health condition? Something else? Once you know what caused it, you can start taking steps to treat the underlying issue.

7) Talk about your history of breast development

It’s important to remember that you’re not alone in your struggle with breast development. In fact, an estimated 40 to 60 percent of all men will experience some form of gynecomastia, or excess breast tissue, during their lives.

For some men, this tissue is nothing more than a nuisance. But for others, it can be a source of tremendous emotional distress.

8) Feel free to have family/friend support you through it all

No one should have to feel self-conscious about their appearance, especially when it comes to something that is out of their control.

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If you are considering surgery to correct your gynecomastia, also known as man boobs, you may be wondering how to get your insurance company to cover the procedure.

Dealing with the condition of gynecomastia can be difficult and overwhelming, but you don’t have to go through it alone.

Talk to your loved ones about your decision to get surgery and see if they would be willing to help support you through the process.

9) Consider your legal rights (if any exist in your state, county, etc.) and how public this will be before going into details with doctors and such

  1. Research your state’s laws regarding insurance coverage for elective surgery. Some states have laws that require insurers to cover certain types of surgery, while others do not.
  2. Find out if your insurer has any exceptions or limitations on coverage for gynecomastia surgery. Many insurers will not cover the surgery if it is considered cosmetic, but some may make exceptions for cases where the surgery is medically necessary.
  3. Check with your employer to see if they offer any type of insurance that would cover the surgery. Some employers offer health insurance plans that will cover elective surgery, so it’s worth checking to see if yours does.
  4. See if you qualify for any government assistance programs that would help pay for the surgery.

10) Follow up with doctor’s office after visit if things don’t go smoothly

After your initial consultation, if you don’t feel like things went smoothly or feel like you didn’t get the answers you were looking for, it’s important to follow up with your doctor’s office.

Here are seven tips to make sure your follow-up goes smoothly:

  1. Make a list of questions or concerns before your call so you don’t forget anything important.
  2. Be polite and respectful when speaking with the staff – remember, they’re just doing their job.
  3. Be patient – it may take a little time to get through to the right person.
  4. Don’t be afraid to ask to speak with a supervisor if you’re not getting the answers you need.

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