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1st step in process to get surgery covered

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1st step in process to get surgery covered
« on: October 07, 2015, 01:16:12 PM »
Is my first step to find a plastic surgeon? Or do I call my insurance company first and ask them what the guidelines on surgery are?? My insurance is pretty good so I'm optimistic but I have no expectations... It's definitely worth a shot! 

Linkback: https://www.gynecomastia.org/smf/index.php?topic=31226.0

Re: 1st step in process to get surgery covered
« Reply #1 on: October 07, 2015, 02:05:43 PM »
It is the rare insurance company that will cover gyne surgery.  However, you should contact them and ask them for their guidelines for coverage of gyne surgery.  You need not begin to tell them everything about yourself -- just ask for their guidelines.

Then, set about to see if you can fulfill those guidelines.  Sometimes they will ask/demand that you be on pain killers for a year, or that you have a specific genetic problem (such as Klinefelter's Syndrome).  They will want to know if you have taken any medications which can produce gyne as a side effect and they will want to know if you have taken any anabolic steroids to build muscles.  And on and on.  However, the 900 lb gorilla is that even if you fulfill all the criteria, the insurance company may still reject any claim for their own reasons -- so be prepared for that.

If indeed you can fulfill some/all of the criteria, you should then visit a plastic surgeon -- and preferably an expert in gyne surgery.  

Good luck!

Dr Jacobs
Dr. Jacobs 
Certified: American Board of Plastic Surgery
Fellow: American College of Surgeons
Practice sub-specialty in Gynecomastia Surgery
815 Park Avenue
New York, New York 10021
Telephone:  (212) 570-6080
Email:  dr.j@elliotjacobsmd.com
Website:  http://www.gynecomastiasurgery.com
Website:  http://www.gynecomastianewyork.com/revi

Re: 1st step in process to get surgery covered
« Reply #2 on: October 07, 2015, 10:14:34 PM »
Thank you 

Re: 1st step in process to get surgery covered
« Reply #3 on: October 14, 2015, 08:51:31 PM »
It is unlikely that  your insurance company will cover the surgery unless you have a disorder, medical condition, tumor, or medicine that has clearly caused the gynecomastia. This occurs in less than 20% of cases. That aside it is important to see a Plastic Surgeon who performs a lot of gynecomastia surgery. There are definitely nuances in technique that can make a difference between an average result and a great result. Good luck.
Dr. Schuster
Chief, Division of Plastic Surgery Northwest Hospital
Private practice in Baltimore, Maryland
10807 Falls Road
Lutherville, Maryland 21093
410-902-9800
email: info@drschuster.com
website: www.CosmeticSurgeryBaltimore.com


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