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Insurance coverage?

  • 4 Replies
Insurance coverage?
« on: November 07, 2018, 02:52:38 PM »
Hi, Will my insurance really cover the procedure if I have documentation from a therapist and doctor? I called two local plastic surgeons and they said they had many patients that were covered as long as they had documentation from doctors/therapist for emotional/psychological reasons.

Linkback: https://www.gynecomastia.org/smf/index.php?topic=34041.0

Re: Insurance coverage?
« Reply #1 on: November 08, 2018, 05:35:16 AM »
The answer to your question lies with your own insurance company.  And within every insurance company, there are many different types of policies with different coverages.

Best to first determine exactly what your policy is with your company.  Then go online and read all the criteria that the company posts about possible coverage for gynecomastia surgery.  Then go about trying to fulfill those criteria.  One thing, though, virtually no company will provide coverage due to emotional distress or psychological reasons -- trying to get approval in this regard would be a waste of time.

And finally, understand that even if you fulfill the required  criteria, the insurance company has the ultimate decision makiing power.  Remember, they are not on your side -- they are on the side of making money for their owners.

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: Insurance coverage?
« Reply #2 on: November 12, 2018, 08:02:35 PM »
I have only had a few patients in which the surgery was covered by insurance. They either had a brain tumor (Prolactinoma) or a direct result of a medication. general psycological well being won't cut it unles they have a special self insured executive plan - if that.
Dr. Schuster
Chief, Division of Plastic Surgery Northwest Hospital
Private practice in Baltimore, Maryland
10807 Falls Road
Lutherville, Maryland 21093
email: info@drschuster.com
website: www.CosmeticSurgeryBaltimore.com


Offline Litlriki

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Re: Insurance coverage?
« Reply #3 on: November 12, 2018, 11:00:41 PM »
Insurance coverage is rare, even though most will say they cover the procedure.  That means that in some rare circumstances, they may very well cover it, but you will jump through a million hoops and even then they may not pay the surgeon (based on a true story!) 
Dr. Silverman, M.D.
Cosmetic and Reconstructive Plastic Surgery
29 Crafts Street
Suite 370
Newton, MA 02458

Certified by the American Board of Plastic Surgery

Re: Insurance coverage?
« Reply #4 on: November 13, 2018, 03:28:40 PM »
Short answer,NO. Even for patients with Klinefelter's its tough today.
Jay M. Pensler,M.D.
680 North Lake Shore Drive
suite 1125
Chicago,Illinois 60611
(312) 642-7777

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