My insurance won't cover my gynecomastia sugery, but covers trans surgeries.

Mod-ulate · 2024-05-16T16:09:40+00:00

For those reporting this as anti-trans, I don't agree.

Anti-trans comments are not welcome on this subreddit, but the main post by OP is not anti-trans.

GreenBasterd69 · 2024-05-16T02:09:17+00:00

Tell them your trans now and need the surgery

sunnyskies01 · 2024-05-16T14:14:15+00:00

Wouldn’t gynecomastia technically cause dysphoria in men, making it a gender issue and therefore it would logically make sense to be covered too

Proof_Option1386 · 2024-05-16T03:21:33+00:00

It's not irony! In order to get surgery, and to have it covered, Trans people have to be diagnosed with Gender Dysphoria, a mental illness whose treatment is gender reassignment surgery. The key here is that their problem is covered as a medical condition.

What you need to find is a doctor who will guide you through not only a mental illness diagnosis, but who can also make it clear to your insurance company that it's cheaper for them to cover your medical condition than to risk a lawsuit. One avenue you might pursue is having a physician deem that you are at risk of breast cancer.

From Anthem:

Medically Necessary:

Mastectomy (including reconstruction if necessary) for gynecomastia in males over the age of 18, or 18 months after the end of puberty, whichever is younger, is considered medically necessary when the following criteria are met:

The tissue to be removed is glandular breast tissue and not the result of obesity, adolescence, or reversible effects of a drug treatment which can be discontinued (this would include drug-induced gynecomastia remaining unresolved 6 months after cessation of the causative drug therapy); and
Appropriate diagnostic evaluation has been done for possible underlying etiology; and
The individual has pain or tenderness directly related to the breast tissue (documented in the medical record) which has a clinically significant impact upon activities of daily living and has been refractory to a 3 month trial of analgesics or anti-inflammatory agents; and
Pre-operative photographs are provided.

SuperRedPanda2000 · 2024-05-16T07:49:33+00:00

Say you are non binary and that you need this surgery to conform with your gender identity. Otherwise, you can try seeing a plastic surgeon or going to Thailand, Bali, Mexico or another Third World country where you could probably get the surgery really cheap.

sar1562 · 2024-05-16T08:09:16+00:00

Sue for discrimination? See if a sue happy lawyer will take ya up on the idea.

RevelationSr · 2024-05-16T16:09:22+00:00

Sad state of "Healthcare."

flipsidetroll · 2024-05-16T14:19:41+00:00

Medical insurances will try to get out of any claim by saying cosmetic. The trick here is how it’s affecting you. It’s generally quite easy to fix. You just need to find a decent therapist, and explain the situation and how your mental health is rock bottom. They will sign off on the recommendation for surgery because without it, your mental health will decline. So you don’t have to be trans, just “suicidal”. Pretty much any surgery can be allowed due to mental health. A friend got a nose job approved and she is far from mentally unstable, just vain. But it worked. Good luck. And hope you feel better after the surgery.

Character_Display945 · 2024-05-18T19:32:31+00:00

The medical system is bullshit.

Insurance in itself is a scam and exploitive. They are not doctors and should not be allowed to practice medicine, especially with the clear conflict of interest for their bottom line. How we have allowed this to continue is beyond me.

Nonbelieverjenn · 2024-05-16T20:49:58+00:00

Start complaining to your doctor about shoulder and back pain from the weight of the tissue. Start a paper trail in your medical records so then the dr can recommend it for you.

Sea_Blackberry5839 · 2024-05-16T08:05:17+00:00

You have to say you're woman

darksoulsguy84 · 2024-05-20T05:26:23+00:00

This is a very real complaint honestly, insurance should cover both of these things. I'm sorry you have to deal with this, good luck on future endeavors.

WannabeLeagueBowler · 2024-05-16T18:06:43+00:00

Why are you glad transgender surgery is covered by insurance?

Not only do you have to pay for your own, now you have to pay for theirs as well.

Zess-57 · 2024-05-16T13:11:34+00:00

Isn't this just breast reduction, which is trans surgery?

Title	My insurance won't cover my gynecomastia sugery, but covers trans surgeries.
Author	sanandrios
Upvotes	407
Comments	30
Date	May 16, 2024 1:49 AM UTC (2 years ago)
Subreddit	Posted in /r/MensRights
Original Link	https://old.reddit.com/r/MensRights/comments/1ct1st9/my_insurance_wont_cover_my_gynecomastia_sugery/
Archive Link	https://theredarchive.com/r/MensRights/my-insurance-wont-cover-my-gynecomastia-sugery-but.1518606 https://theredarchive.com/post/1518606

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