How To Get Gynecomastia Surgery Covered By Insurance?

In India, the majority of health insurance plans cover life-threatening illnesses and medical emergencies, but not cosmetic operations. If you want to get health insurance for gynecomastia surgery, you should be aware that there are some restrictions on the coverage.

Gynecomastia, or breast enlargement, is a disorder where male breast tissues begin to expand unnaturally as a result of hormonal imbalance. Additionally, you can absolutely use your health insurance policy to cover the cost of your therapy if gynecomastia is causing you physical discomfort and other health problems. Let’s talk more about this to clarify when and how insurance will cover the cost of gynecomastia surgery treatment.

Does insurance cover gynecomastia surgery?

Although male breast reduction is frequently regarded as an elective aesthetic procedure, insurance occasionally pays for gynecomastia surgery.

You should speak with your insurance provider for more details regarding what they cover as there may be strict restrictions to qualify for coverage. Many surgeons offer patient financing solutions to make the procedure more inexpensive if insurance does not cover your treatment.

How to Get Gynecomastia Surgery Covered by Insurance?

A doctor is well aware of how upsetting having big breasts is for a man. However, insurance companies do not pay for gynecomastia surgery costs due to purely psychological factors. In order to submit a claim and receive approval for male breast reduction surgery, a number of requirements must be satisfied.

The patient must have true gynecomastia (glandular tissues) or a combination of fat tissues and glandular tissues in order for the primary requirement to be satisfied. Treatment for pseudogynecomastia, which consists only of fat tissues, is viewed as aesthetic rather than therapeutic.

If your gynecomastia began during puberty or adolescence and has continued for two years, you may be eligible for insurance coverage for gynecomastia surgery if you meet the requirements listed below:

  • It achieves grade II, III, or IV gynecomastia.
  • Despite the use of analgesics, the enlarged breasts produce agony.
  • You have stopped using the medications for at least a year that caused the hormonal imbalance that resulted in gynecomastia.
  • Despite addressing the root cause, gynecomastia still exists.
  • The reason of breast augmentation other than hormonal factors has been ruled out.
  • Male breasts have been photographed from the front and side.

In addition to the situations described above, insurance will pay for the procedure if the male patient has Klinefelter Syndrome or there is a risk of developing breast cancer.

The following situations qualify a procedure as cosmetic in nature:

  • when carried out purely for aesthetic purposes.
  • when used to address emotional and social problems.

What expenses are covered by health insurance for gynecomastia surgery?

The costs for gynecomastia surgery that are covered by insurance may differ depending on the insurance company. Overall, insurance will pay for the following expenses:

  • Dr.’s fees
  • Cost of anaesthesia
  • diagnostic procedures and assessments
  • Admission & release from hospitals
  • Charges for the operating room
  • ICU lodging costs
  • Price of medications (pre and post-surgery)
  • Surgical equipment and supplies
  • medical supplies
  • lodging fees
  • after-surgery check-ups

Support and care (in some cases)

The insurance plan can be altered by the patient to provide sufficient coverage for gynecomastia surgery and other potential risk factors. It is crucial that you obtain a policy taking all relevant aspects into account so that, in the event that you do require treatment, the sum insured will be sufficient to meet the associated costs.

Our plastic surgeons at Pristyn Care undertake gynecomastia surgery for both medical and cosmetic purposes. You can have the treatment whether or not you have insurance without worrying about the cost.

We assist with filing claims and receiving clearance from insurance companies, and we accept all significant health insurance policies. If the policy contains any provisions that you should be aware of, such as coinsurance, copayments, or sublimits, our support staff will also explain them to you. Due to the outpatient nature of gynecomastia surgery or male breast reduction surgery, we make sure that the complete insurance claim is paid on the same day.

We provide multiple payment alternatives, including credit card, debit card, check, and No-Cost EMI, for patients without health insurance. The No-Cost EMI service was established so that patients who need immediate care but lack the necessary finances can still choose this option.

It enables the patient to have surgery right away and to pay for it in manageable instalments at their convenience.

Average Cost of Gynecomastia Surgery

Gynecomastia surgery typically costs $3,978, according to the American Society of Plastic Surgeons. This price is based on data from 2018, so anticipate a few hundred dollars more out of pocket for gynecomastia surgery this year.

Remember that the following necessary surgery costs are not included in this cost estimate:

  • surgical facility costs for general anaesthesia
  • Medications on prescription

The level of experience your plastic surgeon has, the cost of living index in your area, the quantity of fat that may need to be removed from your chest area, and whether or not a breast lift may be necessary to achieve the greatest results can all affect the final cost of your gynecomastia surgery.

Can Health Insurance Cover My Gynecomastia Surgery?

Gynecomastia surgery is typically seen by health insurance providers as elective, which means it is not a necessary component of medical care. Because of this, you can be required to pay for the full cost of your gynecomastia surgery.

Because every insurance policy is unique, it’s important to keep in mind that there are some situations in which your operation may be partially or entirely covered by health insurance. Your insurance company might pay all or part of the cost of your surgery, for instance, if your doctor can demonstrate that you frequently get serious and chronic skin infections due to the size of your breasts.


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