How To Get Insurance To Pay For Gyno Surgery? Step-by-Step Tutorial

Helen Skeates
Helen Skeates
14 min read

Are you interested in learning how to obtain insurance coverage for gynecological surgery? It is possible to get insurance to cover gynecological surgery if you can prove that the treatment is medically necessary rather than cosmetic. Gynecomastia, or male breast hyperplasia, is most commonly referred to as “gyno.”

Most of the time, this ailment is so severe that it has a significant impact on people’s emotional and mental health.

Insurance companies, on the other hand, view this condition as purely aesthetic unless it causes difficulties or has an adverse effect on the insured’s quality of life. We’ll go through the basics of gynecomastia, including what causes it, how to cure it, and how to convince your insurance to pay for your operation.

Having gyno is the result of a hormonal imbalance in the body. As I’ll explain later, the imbalance could be produced by a variety of factors. To discover more about this subject, keep reading this article.

What Is Gynecomastia

As a result, let’s clarify the term “gynecomastia.” Gynecomastia is a condition that only affects men, as was previously stated in the article. Male breast tissue abnormally and excessively grows as a result of this disorder.

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However, this is more often a psychological issue than a physical one. This creates a sense of insecurity in men and women of all ages. People with this illness may not be able to relate to others, yet it can have a negative impact on a person’s quality of life.

Anxiety, low self-esteem, and sadness are all possible side effects. Tenderness and soreness in the affected area are other possible side effects of gynecomastia. The imbalance between testosterone and estrogen hormones in the body is to blame for the disease.

It could be bilateral, indicating that both sides are overdeveloped. Alternatively, one side of the body may be affected while the other is unaffected, or both may be affected but one side is worse than the other. Gynecomastia can be long-lasting or short-lived, depending on the individual situation and the treatment. In order to learn more about getting gyno surgery covered by insurance, keep reading.

Causes Of Gynecomastia

Gynecomastia can be a result of the body’s hormones becoming out of whack, as we’ve already discussed. Is it possible that these hormone imbalances are caused by something else? Gynecomastia can be caused by a variety of factors, but here are some of the most prevalent ones that are discussed in detail.

#1. Increased estrogen levels of infants

Gynecomastia in newborn males is rare and normally resolves on its own as the child grows older. A baby’s higher estrogen intake from his mother causes a hormonal imbalance.

#2. Puberty hormonal imbalances

There are a lot of teenagers who suffer from gynecomastia. This is because hormonal imbalances can emerge when the body transitions from adolescence to adulthood. You should get tested if the condition doesn’t go away on its own, in which case you’ll need to see a doctor.

#3. Medical conditions

Gynecomastia can also be induced by hormonal abnormalities brought on by medical problems. Some disorders that can lower testosterone and raise estrogen include obesity, liver illness, renal failure, hypogonadism, and hypoandrogenism, as well as hyperthyroidism, hypogonadism, and hypoandrogenism.

#4. Side effects from prescription drugs or PEDs

As a last point, these hormonal imbalances can be caused by medication you’re taking. You may be taking medication for a different disease, or you may be taking performance-enhancing substances like those used by sportsmen and bodybuilders.

Factors That Determine if Health Insurance Covers Gynecomastia

Your doctor and the insurance company’s assessment of’medically need’ is the most important consideration in determining whether or not plastic surgery is covered by insurance.

There is no medical necessity for most cosmetic procedures like Portland breast augmentation and tummy tucks, thus they are not covered by insurance. The operation may be reimbursed by health insurance in cases of breast reconstruction and gynecomastia.

Gynecomastia surgery may be covered by your health insurance if you are under the age of 18 and meet the following requirements.

Be aware that most insurance policies demand consideration for coverage in one’s teens or early twenties.

Moderate To Severe Chest Pain

Moderate to severe chest pain resulting in a functional or physical disability due to breast enlargement. In contrast, a person’s incapacity to participate in social, sporting, or athletic events is not considered a disability.

Persistent Gynecomastia After Cessation Of Certain Drugs

Gynecomastia occurs even after the patient has stopped taking any medications or substances that may cause it (such as marijuana or other recreational drugs). Testosterone and anabolic steroids are two of the most commonly prescribed medications.

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Gynecomastia Must Be Present For Two Years Or More

Symptoms must have been present for at least two years, and numerous laboratory tests have come back normal. Hormone tests, liver enzymes, serum creatinine, and thyroid function tests are just a few of the tests that might be done.

Other Factors

Gynecomastia patients younger than 18 may only be eligible for insurance coverage if they have stopped taking nutritional supplements, non-prescription medicines, and other substances known to cause male breast enlargement.

In addition, insurance may pay for the operation if the condition is caused mostly by glandular breast tissue rather than fatty deposits. Because of the presence of fat, your insurance company may argue that you need to reduce weight before having the operation.

Consult your doctor and your health insurance provider to see if you are eligible for this procedure.

Gynecomastia Surgery Considerations For Teens

In their late teens and early twenties, many gynecomastia patients seek treatment for the condition. The operation may be paid by insurance if they can establish the above factors.

There are additional considerations for teens and young adults who are undergoing this procedure:

Rule Out Other Conditions First

Ask your physician about alternative possible reasons of gynecomastia that could be treated without surgery before making an appointment with your surgeon.

Losing weight can diminish the look of bigger male breasts, for instance. Before undergoing any type of weight loss surgery, it is recommended that you speak with a qualified professional.

Have Realistic Expectations

Surgery to lower the size of the male breasts can also lessen the appearance of puffy nipples. However, you won’t get a sculpted, strong chest through this method.

Consider the ages of the patients in the before and after images provided by your surgeon. The ‘after’ images of a 25-year-old will be different from those of an 18-year-old. All patients are unique and even the best surgeon can’t change your body type or shape.

Fast Recovery In Most Cases

In most gynecomastia operations, your doctor can obtain good outcomes using Portland liposuction alone. Small incisions in the armpit can be used by some surgeons to remove glandular tissue and fat with ultrasonic liposuction.

A typical recuperation time for most people is five days. After two or three weeks of rest, you can resume strenuous sports and exercise.

Some patients may require skin and tissue excisions, which will add time to the recovery process for more significant gynecomastia instances.

Maturity and Responsibility Are Key

The young male patient must follow his surgeon’s directions to the letter in order to get the greatest potential outcome.

For example, your doctor may require you to wear a compression garment across your chest for two weeks following the procedure. Keep the garment on to preserve the wounds and decrease swelling, even if some younger patients find it irritating.

In addition, the patient needs to take a break from sports and other strenuous activities, which is why many youngsters choose to have their surgery done over the winter break.

Results May Or May Not Be Permanent

It is possible that the outcomes of male breast reduction surgery before puberty may not last. Because the body’s hormone levels are still fluctuating, the illness may recur.

Breast enlargement can occur again as a result of drug use or weight fluctuations in the future. Because of this, many surgeons advise patients to postpone the procedure until they are at least 18 years old. After puberty, adolescents are no longer dependent on their parents for authorization to have the procedure.

However, even if the disease recurs, it may be better to have surgery sooner rather than later if the enlarged male breasts are creating emotional and social problems.


Having a problem that prevents you from living a regular life is enough for a doctor to propose treatment. In the event that it causes you physical discomfort or agony, you may need to seek medical attention.

If it is affecting your mental health, you may want to get help. Based on the diagnosis, the doctor will provide you with treatment alternatives.

And the usual culprits include low testosterone levels, excessive estrogen production, and a host of other problems. If the underlying reason of your problem does not resolve, you will be given the choice of undergoing surgery. The only method to get rid of gynecomastia for good is to have the swollen breast tissue surgically removed by a surgeon.

Make sure your condition won’t return before deciding to go through with this procedure. Your hormones should be in balance. For the sake of preventing the gyno from returning after surgery. The only alternative is another gynecological operation. Let me know if that’s the case, and I’ll make yourself at home.

Is Gyno Surgery Covered By Insurance

Depending on your insurance plan, gyno surgery may or may not be covered. Gynecological surgery is typically not covered by insurance when the procedure is not medically necessary and is just intended to improve the breast’s appearance.

Your insurance policy must be reviewed in order to confirm that the cause for treatment is covered by the policy. In order to convince your insurance company that they should pay for your medical care, you should speak with your doctor.

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Gyno surgery is covered by insurance if you are a teenager with advanced stages of gynecomastia, such as grade two and above. Your gynecologist may also be covered if they cause you to suffer from extreme breast pain and discomfort, even if you are taking medication.

Speak to a medical professional about your health insurance options. Tell the truth about how your illness affects your day-to-day activities and your emotional health. Everything has to go perfectly for your gynecological surgery to be covered by insurance.

Average Cost of Gynecomastia Surgery

Gynecomastia surgery, on average, costs $3,978, according to the American Society of Plastic Surgeons. Gynecomastia surgery costs are expected to rise somewhat this year due to the inclusion of 2018 data.

These costs do not cover fees for critical surgical procedures, such as:

  • a state of unconsciousness under the influence of a powerful
  • Fees for surgical facilities
  • Prescription drugs are a necessity.

For example, the final cost of your gynecomastia surgery may be affected by factors such as how much fat needs to be removed from your chest, the cost of living in your area, and whether or not a breast lift is necessary to achieve the greatest results.

Can Health Insurance Cover My Gynecomastia Surgery?

In most cases, gynecomastia surgery is considered an option rather than a necessary aspect of medical therapy. Because of this, you may have to pay for your gynecomastia surgery out of your own pocket.

In some cases, your operation may be partially or completely covered by your health insurance plan, depending on the policy. You may be eligible for financial assistance with your surgery if your doctor can demonstrate that your excessive breast size is causing you to develop hazardous and long-lasting skin infections.

Final Words

If you’ve read this far, you now know how to obtain insurance coverage for gyno surgery. To everybody who has made it this far, thank you! We truly value the time and effort you have put in. Check out this article on “Franchise Insurance” for more information.

Helen Skeates

Helen Skeates

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