Insurance Coverage for Gynecomastia: Your Strategy

It’s a recurring theme for our gynecomastia patients, and sometimes the distress and frustration come through loud and clear:

How can I get my insurance company to cover gynecomastia surgery?

Unfortunately, the answer remains, “not easily.” Insurance companies generally consider male breast reduction to be a cosmetic procedure, making it routine for them to deny reimbursement.

We still encourage the men we meet to try for coverage for a few reasons, however. One is that if enough guys bombard companies with the need for gynecomastia surgery reimbursement, the situation may eventually change. But the key reason we believe it’s worthwhile for men to be persistent is that these efforts occasionally result in approval.

In fact, we recently learned that a member of gynecomastia.org succeeded in convincing his insurance company to pay for surgery. This particular guy convinced his insurance company that man boob surgery was essential due to mental anguish. This is a good strategy, we believe. Unlike women, guys are not often going to be persuasive with an argument centering on physical problems. But, like women, it seems guys have the best chance for success if they show their insurance company that that they will save money in the long run if they approve coverage for the needed breast reduction.

Man or woman, physical or psychological issues (or both), the idea is the same:

Insurance Company, it’s in your best interest to help me get the procedure I need.

So, how would you go about showing your company that covering gynecomastia surgery for you would be a good investment? Here are some ideas to get you started:

• Request a letter from your primary care physician verifying that your condition is persistent (not caused by medication or lifestyle choices) and causes you mental anguish. Drafting the letter may get you a speedier turnaround.
• Assuming your man boobs do indeed cause you grief, if you haven’t seen a counselor, consider trying therapy and be sure to submit insurance claims for your visits.
• Consult a board certified plastic surgeon and get a surgical plan and a quote for the procedure, along with any other materials they may offer to support your cause

With all this ammunition, call your insurance company and talk with them about coverage. Be prepared to be denied, and assuming that happens, ask what the appeal procedure is.

In preparing your appeal, bundle up all the copies of charts, letters and any other evidence you may have. Write a letter to the firm, detailing the psychological distress your condition causes and the counseling sessions you rely on for help. If you avoid the gym due to embarrassment, discuss that too. Explain how you refrain from activities and touch on other ways man boobs negatively impact your well-being. Be professional and persuasive in demonstrating that your mental health is impacted and, in turn, your physical health.

You may also want to reach out to guys who have been through this process already on gynecomastia.org. They can help you refine your strategy.

We have some experience with insurance coverage for gynecomastia, from what companies tell their patients to what kind of evidence is useful in approaching them. If we can help, contact us online or call 561-367-9101.