There are different stages of Gynecomastia and not all of them fit the criteria to be considered for surgery. Most insurance today have certain guidelines to measure the medical necessity of the procedure. If your condition does not fall under the said criterion, chances are it won’t be covered.
The severity of your condition plays a big part on having full or partial coverage. To be able to know if you qualify for the procedure, you would have to determine the classification and stage of your predicament.
What are the types?
True Gynecomastia
Breast tissues are abnormally swollen even though you are within your ideal BMI.
Pseudogynecomastia
Breast tissues are swollen due to added weight.
Pathological gynecomastia
Breast tissues are enlarged due to endocrinal disturbances. It’s a physical manifestation of a more serious health condition, like Klinefelter Syndrome, certain cancers, or metabolic dysfunctions.
What are the stages?
The disease is divided into 4 stages, depending on the physical appearance of your breast.
Stage 1
Minor increase in the size, no skin excess.
Stage 2
Moderate increase in the size, no skin excess.
Stage 3
Moderate increase in the size, visible skin excess.
Stage 4
Significant increase in the size, visible skin excess.
There is only one surgical approach to fix this condition and it is Reconstructive surgery. This type of procedure falls under the umbrella of Plastics, which most insurance has stricter guidelines because of its nature. If the classification and stage does not meet the guidelines, then it would automatically be ruled out and deemed as not medically necessary, which translates into an automatic out of pocket expense.
To be able to help you understand more, listed below is a sample checklist that most insurance providers use to determine the medical necessity of the procedure. If these criteria are all met, then there is a big chance that your healthcare provider would cover the surgery.
Patient must be 18 years old and has gone through the complete cycle of puberty.
Pseudogynecomastia has been ruled out.
Patient has reached Stage 3 or 4.
Patient has been experiencing recurring pain around the chest area for more than six months, which cannot be cured by analgesics and over the counter non-steroidal creams.
The patient can no longer perform everyday activities due to the level of the pain being experienced.
Patient has undergone a diagnostic battery of tests, such as lab works biopsy and endocrinal testing and has been found that the nature of the condition is pathological.
Surgery is the fastest way to get rid of man boobs, but it is also the most expensive route to go if you don’t meet all the guidelines set by your insurance provider. To learn more about your coverage, you need to get in touch with a physician to assess the stage of your condition. If your health carrier still deems the procedure not medically necessary, then it’s time to try different alternatives, such as exercise or other home remedies.
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