Does Health Insurance Cover Gynecomastia Surgery

Gynecomastia, commonly referred to as “man boobs,” results from the abnormal growth of glandular breast tissue in males.

This condition arises due to hormonal imbalances, primarily between testosterone and estrogen.

Additionally, factors like age, genetics, lifestyle, illnesses, and medications can contribute to its development.

Health insurance for Gynecomastia Surgery
Healthcare coverage for Gynecomastia Surgery: Photo source (Healthline)

Despite its prevalence, gynecomastia can inflict substantial emotional and mental strain on affected individuals.

Consequently, many men explore treatment avenues, including surgical intervention, to address this concern.

What Is Gynecomastia Surgery?

Gynecomastia surgery, performed by plastic surgeons like Dr. Miguel Delgado, M.D., reduces excess breast tissue in men, alleviating related symptoms and enhancing chest appearance with minimal scarring.

Also known as male breast reduction, the procedure aims to achieve a proportional and desirable chest contour.

Does Health Insurance Cover Gynecomastia Surgery?

Insurance companies often view gynecomastia surgery as cosmetic, so they typically do not cover it.

However, exceptions exist when it’s medically necessary.

Discuss your situation with your doctor to explore coverage possibilities.

Examples of conditions that may qualify for insurance coverage include:

Medical conditions

Health Insurance may cover reduction surgery if gynecomastia is caused by a serious medical condition.

Some such conditions are:

  • Cancerous tumors
  • Non-cancerous tumors
  • Liver or kidney disease
  • Thyroid disorders
Functional Impairment

Gynecomastia can cause intense chest pain and discomfort.

Insurance might cover surgery if it significantly impairs physical function.

Medications

Certain prescription drugs can cause gynecomastia.

If these medications are essential for treating other conditions, insurance may cover gynecomastia surgery in such cases.

Genetic disorders

Certain genetic disorders like Kennedy Disease or Klinefelter Syndrome can lead to gynecomastia. In these instances, man boobs surgery may be considered medically necessary.

Other causative factors

Severe gynecomastia can lead to skin breakdown, infections, or painful rashes, especially in extreme cases.

In such situations, insurance may cover surgery as it becomes necessary to alleviate pain and symptoms.

Next Steps

Consult your doctor before gynecomastia surgery to explore insurance options.

Your doctor can assess your eligibility and initiate pre-authorization if there’s a chance of coverage.

It’s crucial to provide detailed medical records to demonstrate medical necessity.

Insurance policies often have strict criteria, and even if the surgery is medically necessary, there’s no guarantee of approval.

However, it’s worth applying because some cases receive individual approval.

Your doctor can guide you through the process to enhance your chances of approval.

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