Is Gynecomastia Surgery Covered by Health Insurance?

Gynecomastia surgery is also known as a male breast reduction procedure. It involves the surgical removal of breast tissue on both sides by a licensed plastic surgeon. Before determining if this procedure is right for you, you need to be aware of the cost and how insurance companies generally view this type of claim. Further, you may also find yourself wondering "is gynecomastia surgery covered by insurance?" Gynecomastia is a health condition in which there is an abnormal growth or presence of breast tissue in males. It can develop in infancy or at any time throughout a man’s life. Typically, an increased level of estrogen in a boy’s or man’s body is the culprit. Regardless of why you have developed “man boobs,” you now want to find a fast, realistic way to remove the from your body.

When to Consider Gynecomastia Surgery

The treatments available for gynecomastia vary considerably based on the underlying cause of the problem. Consider that infants and adolescents often develop gynecomastia because of a temporarily increased level of estrogen associated with birth and puberty. Estrogen is responsible for breast develop in pubescent girls, and it can have the same effect on boys. Because gynecomastia related to this cause may resolve on its own within a few months or years, many physicians recommend time and patience before exploring more extensive treatment options.

In grown men, the development of gynecomastia is caused by the use of various types of medications and steroids, the use of illegal drugs and various underlying health conditions. These health conditions may range from gland conditions to cirrhosis of the liver and even some types of cancer. In these cases, avoiding the substance that contributed to the growth of male breast tissue or treating the underlying condition can result in reduced breast tissue in some cases. Gynecomastia can dramatically affect personal body image and self-confidence. It can lead to teasing and ridicule at all ages. When the condition does not improve on its own, some men pursue surgical removal of breast tissue rather than resort to living with their enlarged breasts for the rest of their lives.

The Cost of Gynecomastia Surgery

According to the American Society of Plastic Surgeons, the average co st of gynecomastia surgery in the United States is slightly less than $4,000. This usually only covers the surgeon’s fees as well as preliminary office visits and post-procedure office visits for follow-up care. It does not cover any of the facility’s fees, medical testing before the procedure, prescription medications, anesthesia or other expenses. Altogether, these expenses may add several thousand dollars to the overall cost of the procedure.

What Health Insurance Covers

Most health insurance policies only cover treatments deemed to be medically necessary by a physician. In addition, the physician typically needs to be in the provider’s network in order to maximum the benefits of health insurance coverage. Unfortunately, gynecomastia surgery is often viewed as an elective procedure rather than one that is medically necessary. According to a study completed by the U.S. National Library of Medicine – National Institutes of Health, approximately 38 percent of providers do not have a clear policy regarding gynecomastia surgery and review each of these claims individually. The remaining providers that participated in the study have a clear policy that is based on specific or defined factors.

Most insurance providers that consider covering this type of procedure take into account numerous factors. These include the patient's age, weight, breast size and body mass index as well as the length of time that the condition has been present and other treatments that have already been tried. According to the findings in this study, insurance providers generally do not base coverage decisions on the physician’s recommendations.

How to Get Insurance to Pay for Gynecomastia Surgery

When other gynecomastia treatments have failed, male breast reduction surgery becomes a primary treatment option. Given the high total cost of the procedure, maximizing the benefits of your health insurance coverage is essential. Experienced plastic surgeons often have years of experience in this area and can provide recommendations and professional assistance. Typically, exhausting all other treatment options is the most important first step. Because insurance companies view this type of treatment individually, moving into a more advantageous health insurance plan should be considered. Gynecomastia can have a detrimental impact on a boy’s or man’s life. In addition to impacting self-confidence, it can lead to bullying, harassment, depression and other issues. Given the high cost of male breast removal surgery, it makes sense to explore and to exhaust all health insurance coverage benefits available. Many plastic surgeons also offer flexible and affordable payment plans to ease the financial burden of out-of-pocket costs.

Sources: https://www.plasticsurgery.org/cosmetic-procedures/gynecomastia-surgery/cost https://www.cigna.com/individuals-families/health-wellness/hw/medical-topics/gynecomastia-hw51306spec https://www.ncbi.nlm.nih.gov/pubmed/31033818