How To Get Insurance To Pay For Gynecomastia Surgery?

What are the Criteria for Getting Medicare for Gynecomastia Surgery?

There are a number of medical conditions that may help you qualify for and make it required, including:

  • If your man boobs are impairing your ability to move or function due to moderate to severe chest pain
  • persistent gynecomastia following the termination of prescribed medications and proper testing for illicit, recreational, or non-prescription drugs or substances known to cause gynecomastia
  • Your problem of breast growth has been bothering you for more than two years, and laboratory tests supporting the identification of medical causes have been normal.
  • Gynecomastia is mostly brought on by your glandular breast tissue, which can be seen on a physical examination or by mammography.
  • To address further medical issues that are affecting your quality of life
  • Quick Facts about Gynecomastia Surgery Coverage by Medicare
  • Breast reduction surgery is only covered by Medicare if it is judged medically essential.

Procedures for cosmetic gynecomastia are not covered by Medicare.

Patients who meet strict requirements and have valid medical recommendations may be eligible for coverage under a Medicare plan.

What is Gynaecomastia Surgery?

Gynecomastia, or enlarged breasts, is a significant psychological and aesthetic issue for many men. Male breast reduction, often known as gynecomastia surgery, is a surgical operation intended to lower a man’s breast size. It can be done for both therapeutic and purely cosmetic purposes.

Why Should I Consider Gynaecomastia Surgery?

For men who struggle with excessive breast size, gynecomastia surgery has the potential to change their lives. It may drastically alter how you feel and appear to others. Consider breast reduction for a number of reasons, including:

  • Gynecomastia surgery can enhance your quality of life and eliminate a number of reoccurring issues that come with having bigger breasts.
  • It will ease the severe discomfort that comes with having man boobs, such as skin chafing and rubbing, redness, and irritation.
  • Your self-confidence will undoubtedly rise as a result of your new physique—no more hiding in a swimming suit and an article of fitting clothing.
  • You will require a medical referral with supporting documentation.
  • You will require a medical referral from your general practitioner or specialist in order to submit your surgery claim to Medicare. You can obtain it both before and after scheduling your initial visit with a plastic surgeon.
  • It’s crucial to provide evidence of medical necessity, including any discomfort and skin issues. It is essential to discuss your symptoms with your doctor so that the clinical need is acknowledged in your referral.

Gynecomastia surgery, often known as male breast reduction, treats males with enormous or excessively developed breasts.

Gynecomastia occasionally might be covered by your health insurance in some circumstances, unlike many plastic operations that are exclusively performed for cosmetic reasons.

More details concerning this element of the procedure are provided below, along with other relevant material.

Factors That Determine Whether Gynecomastia Is Covered by Health Insurance

If your doctor and the insurance provider judge the plastic surgery to be “medically essential,” it will likely be covered by your insurance.

The majority of cosmetic procedures are not covered since they are not medically essential, including breast augmentation and tummy tucks in Portland. But when it comes to gynecomastia and breast reconstruction, health insurance might pay for the procedure.

Gynecomastia surgery may be covered by your health insurance if you are under 18 and meet the following requirements, but insurance company requirements differ significantly.

Keep in mind that most insurance contracts stipulate that a patient be given consideration for coverage when they are in their teens or early 20s.

Moderate To Severe Chest Pain

if the chest pain brought on by the breast growth results in physical or functional impairment. The inability to take part in social activities, sports, or athletic competitions, however, is not regarded as a functional or physical handicap.

Persistent gynecomastia after stopping some medications

After the patient quits using prescription pharmaceuticals, illicit drugs, or substances that could induce gynecomastia, the condition still exists. Testosterone, asthma medications, anabolic steroids, marijuana, and calcium channel blockers are a few of these substances.

Gynecomastia Needs to Have Been Present for Two Years or More

The ailment must have been present for at least two years, and all laboratory tests used to evaluate the condition’s etiology have come back normal. Tests for hormones, liver enzymes, serum creatinine, and thyroid function are just a few of the lab procedures that could be done.

Other Factors

Some health insurance plans will only pay for gynecomastia treatment for patients under the age of 18 once they have stopped taking all dietary supplements, over-the-counter medications, and other substances known to cause male breast growth.

Additionally, if glandular breast tissue rather than fatty deposits are the major cause of the problem, insurance may fund the procedure. If there are fat deposits, the insurance provider might assert that obesity is the issue, so you should lose weight before thinking about paying for the surgery.

Speak to your doctor and health insurance provider to see if the cost of this procedure may be covered before deciding to get it.

Most of the time, Quick Recovery

Your surgeon can obtain outstanding results with Portland liposuction alone in the majority of gynecomastia procedures. Through small incisions in the armpit, some surgeons utilize ultrasonic liposuction to remove glandular tissue and fat.

The average patient requires five days off from work and school to recover. After two or three weeks, vigorous sports and exercise can be resumed.

However, more severe cases of gynecomastia may necessitate skin and tissue excisions, which will lengthen the healing process.

Does health insurance cover gynecomastia surgery?

Correction of gynecomastia is typically not covered by insurance. Each insurance plan, however, is very different. Review your policy thoroughly to determine coverage.

The American Society of Plastic Surgeons has produced a position statement outlining the suggested standards for reconstructive cases of gynecomastia for doctors and insurance. For submission to your insurer, request a copy of this document from your doctor.


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