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Health insurance wouldn't cover surgery as it was "aesthetic"...

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Although I have long had gynecomastia (read about my history here) and considered going for surgery if it wouldn’t disappear, I never actively pursued it for several reasons. It was a burden to me, but with my compression shirts I could deal with it fairly well (see my recommendations here). But now that I have a wife and we consider to have children, I felt a certain line was crossed, where it is no longer a burden to me but also to my wife (who accepts that I cannot go swimming with her), and when we have children, it will also be a burden to them because I cannot do everything with them as a father.

So over a period of two years, I have been trying to get my health insurance to cover the costs for a breast reduction. I saw several medical professionals:
  • My GP was very understanding and supportive and provided a stunning letter of recommendation.
  • A plastic surgeon provided her professional opinion and an assessment of what needed to be done. She also found I was a suitable candidate.
  • I saw an endocrinologist to exclude hormonal or other endocrine causes of my gynecomastia. He found no such causes.

I found it fairly humiliating having to expose myself every time, but kept telling myself that these are professionals and are helping me on my way of getting rid of them. Following an initial rejection from my health insurance, they requested either a mammography or a mammasonography to determine if I have actual gynecomastia or “pseudo-gynecomastia”. The radiologist determined I had “pseudo-gynecomastia” (i.e., basically no gland tissue but almost exclusively fatty tissue). Still, she found that it still concerns tissue that has developed in the wrong place with me as man.

Despite all this, my health insurance rejected the request, arguing that pseudo-gynecomastia should be possible to be reduced through weight loss, and that it would be a “cosmetic” surgery (regardless of the impairments the gynecomastia imposed on me). Now, this is an interesting thing because I have explained several times that I have weighed everywhere between 72 and 96 kg, and my breasts have always remained the same size regardless of my weight.

By that time, I had already done some research, and since I knew gynecomastia.org from way back, I looked to see if there were any recommendations in Europe. Thanks to this forum, I was aware of the costs of a surgery in Poland, and I told my GP that I could actually pay for that privately. Since we also had some other private issues ongoing, he encouraged me to leave the health insurance for what it is and go for it to put this behind me. We did check what it would cost us privately to have the surgery performed with the plastic surgeon that I saw previously, but this turned out to be very expensive. And so, the planning began to have my surgery be performed at the Noa Clinic (read my report here).

Linkback: https://www.gynecomastia.org/smf/index.php?topic=32007.0

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Offline Paa_Paw

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Re: Health insurance wouldn't cover surgery as it was "aesthetic"...
« Reply #1 on: August 22, 2016, 05:15:15 PM »
True, Most policies are like that. Some go so far as to specifically exclude it.
On the other hand, some do cover it.  The cost of the policies that do cover it is usually the reason people do not have those policies.    
Some will cover it but only if you have been with them for a specified period of time. 
Medical insurance is not a mystery, the more exclusions and the higher the co payments, the less the policy is going to cost.  Most people get medical insurance based on how much the policy costs.  Seldom do people look at the exclusions or co-payments. 
Grandpa Dan