Author Topic: 24 years of suffering OVER.....  (Read 3591 times)

Offline BASELINEJ

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First off, I wanted to thank this forum. I read up on how to approach my insurance company when they attempt to deny having gynecomastia surgery.  I was able to succesfully have my denial overturned.  I suffered with this for 24 years!!! and as of 4/4/06 I was finally able to have the surgery approved & paid for by my health insurer. I remember I noticed my problem begin around the age of 12. I was a pretty good athlete and loved B-Ball.  I dreaded playing shirts n skins.  In any event, I started wearing clothes that hid my problem.  I was able to do this for almost 23 yrs..  Then I was watching the Discovery Health Channel and they were doing a hour episode on Gynecomastia. I made an appointment to see a plastic surgeon the next day. I saw my surgeon, he explained that surgery was the only fix and we submitted the info to my insurer.  My request came back denied. I went online found this site, read up on other members experiences with insurance. I wrote a letter of appeal, explaining basically that I suffered for 24 yrs, there isnt another way etc & they sent me a letter telling me it was an approved procedure. Fast forward, 4/4/06 I had my surgery. So far im taking a few weeks off to recover. I havent had any pain, I can notice a signifcant difference already. I cant wait till all the swelling is gone, follow-up appt on tuesday. My advice to any young man going through this, if your under 18 go to your parents asap. It may be somewhat embarrassing but insurance company's are more open to taking care of this if found early on.  18 and above, if you really think your quality of life is being compromised by a condition you have no control over pursue the surgery.

Linkback: https://www.gynecomastia.org/forum/index.php?topic=4980.0

Offline lafilip

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Congrats man! Just remember it might be a while before you see the end results......keep us updated.

Offline BASELINEJ

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My insurer is Anthem Blue Cross/Blue Shield. My Plastic surgeon sent in an initial "pre-determination" that came back denied. What bothered me about that was I didnt get to view the information my physician sent in. In any event, I know it consisted of photos taken & other info.  When the denial came back, it said that the procedure was "expiremental". So that sorta suprised me, as the surgeon had prepared me for a possible denial for "cosmetic procedure". So I came onto this board, another member gave details about insurance appeals. So I went on the American Plastics Surgeon's website got a "Position paper" on gynecomastia and how insurers should handle it.  Also, the website explains the difference in a cosmetic procedure versus a "reconstructive" procedure. Gynecomastia is reconstructive NOT cosmetic. Plus, I added that women have reconstructive breast procedures routinely and are covered as such. So I sent in my appeal letter hitting all these high points and a Physician reviewed my letter and TOTALLY OVERTURNED the previous decision. I was suprised to log onto my insurers website ,go under pending cases and see my case with this message "Totally Overturned".. I clicked on it and it went on to say totally necessary.  So dont get discouraged, it can be done.  My Physician office wanted a copy of my appeal letter because I was the first case he had paid for by insurance.

Offline Grandpa Bambu

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  • 31 Year Gynecomastia Victim...
Quote
I suffered with this for 24 years!!! and as of 4/4/06 I was finally able to have the surgery approved & paid for by my health insurer.

Excellent Dude!  ;)

Welcome to the 'Other Side'....  :)

John.
Surgery: February 16, 2005. - Toronto, Ontario Canada.
Surgeon: Dr. John Craig Fielding   M.D.   F.R.C.S. (C) (416.766.8890)
Pre-Op/Post-Op Pics

Offline Hypo-is-here

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BASELINEJ

In the US it is insurance companies, in the UK it is the NHS- both attempt denial on cost issues as opposed to genuine moral grounds.  

The battle feels like insult added to injury and it stops many a man in their tracks, they just don’t feel like they have it in them to win through, after all it is a battle to acknowledge that you have this condition to start with let alone make the step of bringing it too the attention of a gp.

I won my way through in the UK, I learned far more than the people who would deny me and I articulated my way past their flawed logic.

Congratulations in getting through the quagmire of denial.

It certainly isn’t easy as you are well aware- enjoy the benefits and fly the flag and give people hope by re-telling your story to subsequent newcomers who can’t see light at the end of the tunnel.

Best to you, enjoy the freedom!

Offline BASELINEJ

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« Last Edit: July 21, 2006, 03:35:47 PM by BASELINEJ »

Offline oldgynodude

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Cool, that's a great thing to hear. I paid for my own surgery and feel no regret for doing so, if more people can get insurance to cover it I am happy for them also.


 

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