Getting covered

Getting covered
« on: December 04, 2018, 11:20:30 pm »
I had one more quick question,
What is the process of getting insurance to cover the surgery? First go to a consult and then the surgeon sends a request or do I send the request? I have United Healthcare, thanks!

Linkback: https://www.gynecomastia.org/smf/index.php?topic=34082.0

Offline hammer

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  • 3021
Re: Getting covered
« Reply #1 on: December 06, 2018, 12:09:22 pm »
I know nothing about your health care, however, if you are in the US most insurance companies do not cover any male breast reduction surgery that I know of! I've been here on the forum since 2011 and there has been very few time that it has been covered. There has been active service members that have gotten it done through tricare due to interference with body armor.

Good luck!
I'd rather be hated for who I am, then loved for who I'm not!

I am who I am,  and I'm not going to change to please anyone!

https://www.gynecomastia.org/smf/index.php?topic=24515.0

Offline Paa_Paw

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Re: Getting covered
« Reply #2 on: December 07, 2018, 04:05:05 am »
Hammer is totally correct.  I have been here over 15 years, actually coming over from a previous older site which closed when this one began.   There are exceptions, but many policies actually specifically exclude this kind of surgery.  Cost is often a factor in choosing Medical coverage and only the most expensive policies cover male breast reduction. 
All you can do is ask and see if they will approve the procedure.  You might need to start with a referral from your primary care Doctor. 
Grandpa Dan

Re: Getting covered
« Reply #3 on: Yesterday at 01:10:43 pm »
A few realistic facts about insurance coverage for gynecomastia.

Yes, some insurance companies do cover it.  However, it is all in the fine print.  You should read your particular policy cover to cover and make a list of everything they require in order for you to be considered for coverage.  And then set out to fulfill those requirements.  Also, realize that no insurance company will guarantee payment -- even with a pre-determination letter from your surgeon.  And since insurance coverage is so rare (and inadequate for the time/effort put in by the surgeon), most surgeons will require pre-payment for the operation.  After surgery, the surgeon will then submit a bill to insurance with a copy of the operative and pathology reports and office notes.  Finally, it is wait and see time -- which may take months.  

And, if any payment is made, it will go like this.  No matter what the surgeon charges, the insurance company will have its own fixed maximum amount of what it will pay (and they will never tell the patient or the surgeon ahead of time).  Then there are deductions:  deductibles, co-insurance, etc.  They do very well in whittling down what they eventually will pay.

Unfortunately those are the rules we have to play by.

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

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