Cosmetic & Reconstructive Surgery Expert Forum
Gynecomastia
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Questions in the Cosmetic Surgery forum are answered by Dr. Howard Rosenberg and Dr. Wolfeld. Topics include bariatric surgery reconstruction, breast augmentation, chemical peels, cosmetic or reconstructive surgery, face lift, nose reconstruction, and tummy tucks.

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Gynecomastia

My question is how can i get my insurance to approved my gynecomastia surgey as reconstructive and not cosmetic.  I am 26 years old and about 4 years ago I have gastric bypass surgery.  Since then i have lost about 150 lbs.  i have a lot of extra skin in my chest area and am too self concious to go without a shirt on.  Not only that, i also have back pain, poor posture and hygiene and rashing.  The insurance still sees this as a cosmetic procedure and I can not afford to pay for all of this out of pocket.  What should i do?
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I would agree that your problem is not cosmetic, but reconstructive.  If your doctor has written to the insurance company for pre-authorization for this procedure and surgery has been denied, then I would take steps to directly contact your carrier and obtain information about the basis for their decision.  Also ask for the criteria they use to make the distinction between cosmetic and reconstruction surgery.  Review this information with your doctor.  

Finally, if all else fails, you may consider obtaining legal help to threaten a bad faith legal action.  Another option would be to take the issue up with your state's insurance commission.
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