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Does Insurance Cover Gynecomastia


Gynecomastia or the condition where males have enlarged female like breasts and need to go in for surgery to decrease them, is basically a cosmetic surgery. It comes under body contouring and body sculpting. It is done to beautify or improve the body structure and as such, strictly speaking, is not a medical procedure.

Insurance coverage varies from company to company and each one has its own policies and principles to pay or not. They go through the records and the medical certificates and find out the causes and the reasons for the medical procedure. If they are satisfied that it is a medical condition requiring this surgery, then they may pay the insurance cost. One has to discus this before undergoing the surgery. If the patient feels that surgery is necessary and if the insurance company refuses to pay for it, then he should undergo it at his own cost.

Though most of the insurance companies do not pay for gynecomastia surgery, one can always appeal if the company turns them down. Most insurance companies refuse on the grounds that it is a cosmetic surgery and not necessary for good health and physical condition. They do not care for social or emotional reasons for undergoing surgery for gynecomastia. This surgery is usually done to save the person from embarrassment and social shyness. A patient chooses this method when he feels shy to go about shirtless or if he hates uncovering himself during swimming or other similar activities.

However, if gynecomastia reaches the proportions of being a medical hazard, and the surgery has to be done under this condition, the insurance company may pay if the doctor certifies that the patient was in dire need of the surgery and could not continue without undergoing it. If the patient says that it is congenital and it is absolutely essential to improve the condition, some companies may relent, consider it, thoroughly investigate it and then give an insurance coverage.

If the patient has breast tenderness and can prove it, or if the doctor certifies this, then there is a remote chance of insurance coverage. If the patient has normal weight and still has large breasts, it will be a plus point in his favor as far as the insurance company is concerned. If he is overweight the chances are very slim. Some new insurance companies may consider covering this type of surgical procedure because more than sixty percent of males have it and need to go in for surgery.

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