Why is gynecomastia not covered by insurance?

Insurance companies usually try to differentiate between procedures that are essential and that are not. For example, procedures like heart surgeries, cancer surgeries are all essential surgeries because if these surgeries are not conducted on a patient then the person might not survive. On the other hand, surgeries like facelift are not at all essential because without these surgeries the person would lead a normal life. Gynecomastia surgery falls under the second category.

Problems with gynecomastia are both physical and mental. Physical problems include the presence of breasts like that of a female with loss of the classical male aesthetic chest. Mental problems include anxiety, a sense of inferiority complex and in extreme cases, depression which are all exacerbated by peer ridicule. However, all of these problems are not considered as life threatening even though in some cases of gynecomastia there are thoughts of suicide.

So, does gynecomastia cause a cosmetic concern only? The answer is NO! In some cases, there can be significant pain associated with breast enlargement while others may have functional impairment. In these select cases, and in cases associated with Klinefelter’s Syndrome, insurance companies may actually cover the cost of gynecomastia surgery.

Some insurance companies may actually cover the cost of gynecomastia surgery as already mentioned. The eligibility criteria for such coverage include: persistent breast swelling of more than 2 years, of higher grade, causing postural problems or physical discomfort associated with pain and is not induced by medication like anabolic steroids (seen in bodybuilders). Pseudogynecomastia, if diagnosed, would generally be excluded from insurance coverage.

In India, most insurance companies would not cover the cost of gynecomastia surgery as it is labeled as a Cosmetic Procedure. However, some insurance policies especially higher end corporate insurance policies may cover this surgery. Please check with your insurance provider to see if they are willing to cover your surgery cost.

Prof. (Dr.) Souvik Adhikari understands that gynecomastia surgery is not covered by insurance in most cases. Therefore, he has devised special package rates which would be affordable for most patients. He understands that many patients are students who might have a problem with financing their surgery and therefore offers discounts. For more information, visit the site dedicated to Gynecomastia:

https://gynecomastias.com/