Is Gynecomastia Surgery Covered by Insurance in India?

Gynecomastia surgery is a procedure to remove overdeveloped breast tissue in men. It is also known as breast reduction surgery. By performing this surgery, the doctors remove the excess fat or glandular tissue from the men's chest area. The two main types of surgeries are:

Liposuction- Under this method, the doctors use a tube or cannula to remove the excess fat from the chest.

Glandular Tissue Removal- This is a surgical procedure used for severe cases of gynecomastia.

Now that we know what the condition means, coming to the next crucial question: Is gynecomastia surgery covered by insurance? Let’s find out.

Insurance may or may not cover gynecomastia surgery. It depends on the nature of the surgery. Gynecomastia insurance covers the cost of surgery only if it is performed for medical reasons. For example, if the condition is causing other health issues, you may get insurance coverage. You may also get coverage if the surgery is performed to remove the glandular tissue rather than fatty deposits in the chest.

However, if performed for cosmetic reasons or to enhance the self-confidence and appearance of a person, insurance providers are most likely to reject its coverage.

Also Read: What Health Insurance Plan Covers?

One can get gynecomastia health insurance coverage if they are able to prove the medical necessity of getting the surgery done. In the following cases, this surgery may be included in the insurance policy.

Medical necessity- If gynecomastia causes significant pain, functional issues, or discomfort, it may be considered medically necessary to perform the surgery. In such cases, it will be included in the insurance plan.

Medical Condition- At times, gynecomastia develops as a result of an underlying medical condition. It may develop due to liver problems, hormonal imbalance, or other medications that one may take. Here, the surgery may be approved by the insurance provider.

Other Methods- Some insurers may require you to try non-surgical methods to treat the condition. If nothing works, they may approve the surgery.

To get gynecomastia insurance coverage for the surgery, both the doctor and insurance company must deem it medically necessary.

Every insurer has different terms and conditions, inclusions and exclusions in their insurance plans. Thus, the expenses covered under gynecomastia insurance may differ from one provider to another. Here are some expenses that may be generally covered.

• Doctor consultation charges

• Pre-surgery diagnostic tests and evaluations

• Hospitalisation charges

• Anesthetist fees and anesthesia charges

• OT and ICU costs

• Hospital room rent

• Medicine costs and pharmacy bills

• Consumable items, such as syringes, gloves, cotton swabs, dressing tapes, etc.

• Post-surgery doctor follow-ups

Gynecomastia surgery coverage may or may not be included in your insurance plan. Therefore, you must follow a few steps to check the coverage.

Enquire with the Insurance Provider- Get in touch with the insurance company and provide them with all the necessary details about the condition and the surgery. Ask the insurer if the surgery is included in the coverage and what documents are required for verification.

Check the Policy Documents- You may also read up on the policy documents to find out if gynecomastia surgery is included in the coverage. The document may also specify what conditions must be satisfied for the surgery to be included in the policy.

Check Pre-Authorisation- You may have to get a pre-approval letter from the insurance company so the surgery cost may be reimbursed to you. Make sure to follow the process carefully to avoid coverage issues.

The waiting period is the cooling time in a health policy. Specified diseases and ailments will be covered under the scope of insurance only after the waiting period is over. The waiting period may vary between different insurance providers.

While most insurance providers have a waiting period of 2 years, in some cases, it may range from 6 months to 3 years. Thus, if you require gynecomastia surgery for medical reasons, you may have to wait for 2 years before the surgery can be included in the gynecomastia insurance coverage.

You can find out the exact waiting period of your health insurance with the insurance provider.

Also Read: What is Waiting Period in Health Insurance

You can claim coverage for gynecomastia in two ways: cashless and reimbursement. Here is how you can raise a claim under each category.

Cashless Claim

Pre-Authorisation- Since gynecomastia surgery is pre-planned, you must inform the insurance company about the scheduled surgery and obtain a pre-authorisation letter.

Hospitalisation- Once your pre-authentication form is approved, you can be admitted to the hospital and get treatment.

Cashless Payment- After the surgery is completed, the insurance company will directly settle the bill with the hospital as per the terms of the policy.

Reimbursement Claim

Inform the Insurer- Inform the insurance company about the planned surgery for gynecomastia well in advance, as mentioned in the policy.

Hospitalisation- You may get admitted to any hospital for the surgery. After the surgery is completed, you must settle the bills with the hospital and preserve all the bills and invoices.

Submit a Claim- You may fill out the claim form and submit all the documents and bills to support your claim. The insurance company will verify the documents and claim. After successful verification, the insurer will reimburse you with the claim amount as per the policy’s terms.

Also Read: 9 Health Conditions Not Covered in Health Insurance

Gynecomastia Grade- Gynecomastia has four grades. The surgery for each grade varies significantly depending on the amount of glandular tissue that needs to be removed. The surgery also varies with the severity of the condition, which may affect the surgery cost.

Expertise of the Surgeon- The expertise of the surgeon performing the procedure also determines its cost. Gynecomastia surgery requires expertise and experience to perform the procedure successfully. The charges of an experienced surgeon may be high, which can increase the overall cost.

Surgery Methodology- Two surgery methods can be used in gynecomastia. The method of the surgery also determines the cost of the surgery.

Location of the Surgery- In metro cities, such as Mumbai, Delhi, Bangalore, etc., the cost of gynecomastia surgery is high. However, in smaller cities, the cost may be lower. So, the location of the surgery also plays a role in its cost.

Hospital Facilities- If you choose premium hospitals and clinics, the cost of the surgery may be significantly higher as they have advanced facilities.

Additional Costs- Besides the surgery cost, many other miscellaneous expenses are involved in the surgery, which affects its cost. Some additional expenses include diagnostic tests, doctor follow-ups, anesthesia charges, etc.

Health insurance online is necessary to protect you not only from gynecomastia but many other medical conditions and emergencies. With the right insurance coverage, you can get adequate financial assistance for yourself and your loved ones in case of illness and injury.

You can rely on TATA AIG’s affordable mediclaim policy starting at ₹22 per day. Our plans provide cashless hospitalisation, pre-existing and critical illness coverage, add-on options and many other benefits. Thus, our health policies ensure that you can avail yourself of the best medical facilities without draining your finances.

If you have old parents to take care of, we can assist you with our health insurance for parents. TATA AIG Elder Care plans are specifically curated for elders above 61 years of age. The plan offers plenty of benefits, such as post-operative care, home care treatment cover, in-patient treatment cover, pre and post-hospitalisation expenses cover, AYUSH benefits and much more.

With lifelong renewability, you can rest assured that your parents will continue getting coverage as long as they live! To find out more details about our various health insurance plans, you can contact our customer assistance team.

What causes gynecomastia?

• Several reasons may cause gynecomastia or increase its chances.

• Hormonal changes or imbalances during puberty

• Decrease in the testosterone levels in the body

• Certain medications, such as antidepressants, blood pressure medicines, etc.

• Medical conditions, such as liver disease, tumours, etc.

• Use of alcohol and drugs.

What is the age to get insurance coverage for gynecomastia surgery?

While there is no standard age, insurance companies may have different age limits for their plans. You must enquire with the insurance provider about the age criteria for the same.

What is the recovery time after gynecomastia surgery?

The maximum recovery time may last 4 to 6 weeks. However, most patients recover and are able to return to their normal activities within 1 to 2 weeks.

Does Gynecomastia health insurance cover all the expenses related to the surgery?

The extent of expenses covered under health insurance depends on the insurer and the type of plan that you have chosen. While some insurance plans may cover all the costs, some insurance plans may have exclusions that you must be aware of.

Is gynecomastia surgery safe?

Yes, gynecomastia surgery is safe when performed by an expert medical professional. Like any other medical surgery, it involves certain risks that can be minimised with proper care and the help of an expert surgeon.