Gynecomastia is a condition causing growth in the breast tissue. It can occur naturally, but is also a common side effect of drugs and medications such as anabolic steroids, making it common in bodybuilders.
Naturally occurring Gynecomastia, like cases during puberty, usually mean there is a combination of fatty tissue and glandular tissue. Steroids cause Gynecomastia to develop much more quickly and typically lead to more serious cases. You have three treatment options for your condition, and surgery is typically the favored option.
Is Gynecomastia surgery covered by insurance?
This all depends on your insurance provider. Many cover it, but then again, many don’t. When it comes to treatment for Gynecomastia, there are really only three options:
- Gynecomastia Pills: the most affordable of the actually physically-altering solutions, pills don’t always work and some have side effects.
- Gynecomastia Surgery: the most expensive and most personalize solution for dealing with Gynecomastia.
- Compression shirts: Gynecomastia vests compress the appearance of your chest to help hide the issue; they do nothing to cure it in any way.
Surgery is the most permanent and personalized option, but it’s also the most expensive. If you’re considering Gynecomastia surgery, you should check if your insurance plan has any coverage for it. Mass market Gynecomastia solutions like pills and compression vests don’t quite have the long-term effects that surgery does.
You should speak with a Gynecomastia specialist about your treatment options and see if surgery is a necessary action. They will walk you through the process and ask about your specific case of Gynecomastia. They may tell you about healing times and even give you a quote. It’s important to research before choosing to go into Gynecomastia surgery and make sure that it’s the best option for you. Less severe cases of Gynecomastia can sometimes be handled by doctor-prescribed medications.
Liposuction & The Procedure
Liposuction alone will not cure the condition. Many patients are misled thinking that liposuction will help them, but all it truly does is suck out the fatty tissue simply leaving a smaller version of what you had previously.
During actually Gynecomastia surgery, you’ll be put under general anesthesia for about two hours. Before going into surgery, you’ll need to be off of any anabolic cycle for at least six weeks. Anabolic steroids have side effects that could result in complications during surgery. Additionally, the altered liver function caused by anabolic steroids can also lead to risky side effects during anesthesia.
After surgery, you can return back to low impact exercise about a week after your procedure. Light-weight training can return in about three weeks, with the obvious exception of chest and back exercises. Within four weeks, you can lightly start training your chest and back again. About six weeks after your procedure you can return to your normal routine.
A Custom Approach
An experience Gynecomastia surgeon will tailor the surgery to you, depending on your body shape, contours, and the severity of your case. Surgery is guaranteed to get rid of Gynecomastia. Patients who have underwent surgery claim that it’s the best option as long as you’re able to afford it.
So, how do you get gyno surgery covered by insurance? First, you have to go through your insurance coverage guidelines and see if it’s mentioned. This will tell you exactly what is and what isn’t covered by your current plan. Different companies have different policies, so it’s important you check your own personal plan to see if coverage is available.
The guidelines will give you a clear idea on what surgeries and medications are and are not covered. After that, talk to your doctor about the next step. Ask them about your condition, the severity, and how they would go about scheduling a surgery. Get a price quote and see if it’s an option that fits within your budget. Your doctor will also be able to help you get coverage for Gynecomastia surgery, and will be one of the best people to correspond with your insurance company regarding the surgery. Your doctor will be happy to help you see if yo are covered, as that is their job. In fact, the American Society of Plastic Surgeons states that Gynecomastia of grade 2 and above has to be covered by your insurance plan.
In most cases, the doctor will start getting in touch with your insurance provider and advocate for your surgery. They will also conduct lab tests and use results to help back their claim for you. The majority of insurance companies follow the below list of requirements if you want coverage for your Gynecomastia surgery:
In general, to be eligible for Gynecomastia surgery you need to fulfill all of the following criteria:
- You must have what they consider a “well-defined” physical abnormality that results in a medical condition requiring treatment.
- The physical abnormality must have resulted in a deficit in functioning.
- The deficit in functioning must be persistent or recurring.
All men with Gynecomastia should meet these criteria.
When will coverage be provided?
For some people, Gynecomastia can cause serious health problems. Many times, there can be tumors developing along with the breast tissue, and in other there’s a possibility for extreme pain. For some, surgery is a necessity. Before you’ll get coverage, your doctor will be expected to de extensive research into your condition and put you through multiple checks and tests. The insurance company will want proof that surgery is a necessity.
When won’t coverage be provided?
There are four grades of Gynecomastia, and in most of these stages the effects are primarily psychological. Gynecomastia can crush a man’s self-esteem and lead to poor self-treatment and even depression. This is something hundreds of thousands of men go through, but from an insurance company’s outlook and point-of-view, that’s not valid reasoning to provide coverage for Gynecomastia surgery.
Unless you suffer extreme pain or there is a cancerous tumor growing, Gynecomastia surgery is considered a cosmetic procedure and is therefore not covered by insurance companies. 99% of the time, if you or your doctor mentions psychological benefits, coverage will not be given, at least not for the first request. If you need coverage for Gynecomastia surgery, your doctor will need to pull lab results and tests in order to convince the insurance company to provide coverage.
What If I’m denied?
You will almost never get approved coverage for your Gynecomastia surgery on the first try unless you have very strong evidence in your favor. Once you get denied the first time, you’ll need to appeal their decision and get in touch with your surgeon who will help make your case for you.
Why isn’t coverage provided?
In order to understand why coverage isn’t provided in many cases, you have to look at it from an insurance company’s perspective. It seems Gynecomastia is typically considered a cosmetic condition more than a life-threatening one, and in most cases, it usually is. Insurance companies likely feel that if they begin to cover all cases of Gynecomastia surgery, others will come in and ask for coverage on their cosmetic surgeries which would mean a lot more coverage would need to be offered.
Other Payment Options
If you cannot get insurance coverage from your company, you can still finance the surgery. There are many companies who finance cosmetic surgeries. Going through one of these companies will allow you to get the life-changing surgery you need and stay within your budget.
Pros & Cons of Gynecomastia Surgery
The pros of Gynecomastia surgery well out-number the cons:
- Gynecomastia surgery is the only option that guarantees permanent reversal of Gynecomastia.
- Gynecomastia surgery is the only option customized to each patient; the surgeon will look at your individual case and body.
- You will know exactly what to expect after surgery and you will be discussed with regarding the appearance after the procedure.
- It’s a life-changing difference that will boost your confidence and self-esteem.
There is really only one con with Gynecomastia surgery, and that is the lack of coverage. Surgery is expensive, but again, if you have the money, it’s worth every penny and will positively affect your life going forwards.