Hello, I hope this is the right place to post this.
I suffer from gynecomastia (enlarged male breaset tissue) on both breasts; I have had it since I was a teenager (at least from age 12 or 13 and onward).
I visited a plastic surgeon in order to discuss options for having the gynecomastia removed via a reduction mammaplasty surgery, and we talked about the possiblitiy of having my health insurance cover the surgery by showing that the surgery is medically necessary. I am writing a letter to the insurance company to argue and show that there exists a medical necessity, and I need help with knowing how to prove medical necessity; what factors does the health insurance company consider in order to warrant medical necessity? These are the arguments I have so far regarding medical necessity:
the reduction mammaplasty surgery is a standard medical practice; the reduction mammaplasty surgery is approved by the FDA for the correction of gynecomastia; I have two physician’s recommendations recommending the reduction mammaplasty surgery to correct the gynecomastia; the physicians have stated their preference that the reduction mammaplasty surgery be performed; the Surgery is of medical necessity because I experience significant pain in the chest and nipple area due to the gynecomastia, as well as because I have suffered and continue to suffer significant mental and emotional anguish from the embarrassment of having enlarged breast tissue as a male (also, I have preexisting mental health conditions that become gravely aggravated by the embarrasment); and the gynecomastia from which I suffer put me at a greater risk for developing breast cancer. (cancer runs in my family, on both sides).
Please let me know if I am going in the right direction, and what arguments or factors I should include. By the way, the insurance company is SelectHealth, if that matters.
Thank you in advance!
submitted by /u/PristineLegalShits
[link] [comments]Hello, I hope this is the right place to post this. I suffer from gynecomastia (enlarged male breaset tissue) on both breasts; I have had it since I was a teenager (at least from age 12 or 13 and onward). I visited a plastic surgeon in order to discuss options for having the gynecomastia removed via a reduction mammaplasty surgery, and we talked about the possiblitiy of having my health insurance cover the surgery by showing that the surgery is medically necessary. I am writing a letter to the insurance company to argue and show that there exists a medical necessity, and I need help with knowing how to prove medical necessity; what factors does the health insurance company consider in order to warrant medical necessity? These are the arguments I have so far regarding medical necessity: the reduction mammaplasty surgery is a standard medical practice; the reduction mammaplasty surgery is approved by the FDA for the correction of gynecomastia; I have two physician’s recommendations recommending the reduction mammaplasty surgery to correct the gynecomastia; the physicians have stated their preference that the reduction mammaplasty surgery be performed; the Surgery is of medical necessity because I experience significant pain in the chest and nipple area due to the gynecomastia, as well as because I have suffered and continue to suffer significant mental and emotional anguish from the embarrassment of having enlarged breast tissue as a male (also, I have preexisting mental health conditions that become gravely aggravated by the embarrasment); and the gynecomastia from which I suffer put me at a greater risk for developing breast cancer. (cancer runs in my family, on both sides). Please let me know if I am going in the right direction, and what arguments or factors I should include. By the way, the insurance company is SelectHealth, if that matters. Thank you in advance! submitted by /u/PristineLegalShits [link] [comments]Read Morer/HealthInsurance