Surgical Management of Gynecomastia: A Review of the Current Insurance Coverage Criteria.

BACKGROUND: Gynecomastia is a common condition that can be corrected with surgical excision of the breast tissue. Unlike the policies available for reduction mammaplasty in women, gynecomastia policies are variable and not based on strong scientific evidence. This study reviews U.S. insurance policies for coverage of gynecomastia surgery and compares these policies to the guidelines put forth by the American Society of Plastic Surgeons. METHODS: Sixty U.S. insurance companies were selected based on their market share value. Medicare was also evaluated. The policy for each company was identified using a Web-based search or by contacting the company directly. Policies were reviewed to abstract coverage criteria. All information gathered was compared to national recommendations. RESULTS: Of the 61 companies evaluated, 38% did not have a well-defined policy for gynecomastia surgery and assessed each request on a case-by-case basis with no defined criteria. The remaining 62% of providers held a defined policy. Companies often required thorough documentation of breast size, body mass index, extent and duration of symptoms, and prior treatments, but requirements varied between insurers. Many of these policies were limited in their coverage, e.g. they would cover tissue excision but not liposuction. Fourteen companies would consider of coverage for patients younger than 18 years. CONCLUSIONS: Coverage of gynecomastia surgery varies across insurers. Insurance company considerations do not often align with patient concerns and physician recommendations on gynecomastia and its treatment options. Coverage criteria should be reevaluated and universally established, to expand access to care and improve treatment efficiency.

Cost-effective management of gynecomastia.

BACKGROUND: Routine endocrine screening of idiopathic gynecomastia has been advocated, but may not be cost effective. We carried out a cost-benefit analysis of this approach. METHODS: A retrospective study (1992 to 1997) of 87 adult males with symptomatic gynecomastia was performed. RESULTS: Thirty-four (39%) patients had extrinsic causes; 53 (61%) were considered idiopathic. Forty-five idiopathic cases underwent endocrine testing: beta human chorionic gonadotropin alone, 16; and beta human chorionic gonadotropin, LH, estradiol, testosterone+/-testicular ultrasound, 29. One (2%) occult Leydig cell testicular tumor was detected. Forty-four patients had normal studies and remain well after local excision. CONCLUSION: Routine endocrine evaluation of idiopathic gynecomastia is rarely productive; such testing is best done selectively.