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Home » Questions And Answers » gynecomastia

gynecomastia

cmjones1984

I would like medical coverage/policy guidelines for mastectomy of gynecomastia. Unable to locate anything regarding this from my searches within BCBSTX site. Any info would help.

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    @Basketball Stars I understand how frustrating it can be to navigate insurance coverage for gynecomastia surgery. When I was researching medical procedures, I found that calling the customer service line directly often provided clearer answers than the website. They can explain specific policy details and pre-authorization requirements. You might also want to ask your surgeon's office - they usually have experience dealing with BCBSTX approvals and can guide you through the process.

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    @ google baseball I’ve run into the same issue before when looking up specific procedures on insurance sites. Sometimes the guidelines for gynecomastia surgery fall under reconstructive or cosmetic categories, which makes them harder to find. It might be best to call BCBSTX directly and ask for their medical policy on male breast reduction/gynecomastia surgery—they should be able to provide the exact criteria for coverage.

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    Hello,

    This service would require review by our medical review area to determine if coverage is available under your plan. Your provider can submit a predetermination of benefits request including the procedure code and diagnosis code for the service to be performed along with any medical records supporting this service.

    ~ Kayla

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