Will Insurance Cover Gynecomastia Surgery?

In most cases, insurance will not cover male breast reduction. Unfortunately insurance companies do not see gynecomastia breast reduction as medically necessary, but view it as a cosmetic procedure.

Adolescent boys have a higher chance of getting coverage than do men, but it is still an uphill battle. There was a court case in 2007 where a father sued his insurance company for not covering his son’s surgery, it went all the way to the New York Supreme Court and ultimately the insurance company had to pay $5000 of the $7500 fee.  This did not however, set a precedent as hoped.

There is an excellent article on gynecomastia.org called “A Success Story-Start to Finish” written by a Mother about her son and everything they went through to get their insurance to cover his surgery. In the article she explains exactly what they did and how they did it to finally get approval. This is a long and difficult process and you can’t be sure of an outcome in your favor.

Dr. Delgado is always willing to submit a letter to insurance companies on behalf of any of his gynecomastia patients that he feels may have even a slight chance of getting coverage. Even though the surgery itself most likely will not be covered, there are expenses that under most policies will be covered, such as; required blood tests prior to surgery, pathology, and all prescriptions.