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Is Gynecomastia Surgery Covered by Insurance in India?

Gynecomastia surgery, also called male breast reduction surgery, is covered by health insurance in India when performed for medical reasons. The surgery is performed to remove enlarged or overdeveloped breast tissues in men. However, if the surgery is performed for cosmetic reasons, the treatment won’t get covered by health insurance or mediclaim.

Gynecomastia surgery, also called male breast reduction surgery, is covered by health insurance in India when performed for medical reasons. The surgery is ... Read More

Gynecomastia Treatment Insurance Claim

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Is Gynecomastia Surgery Covered by Health Insurance?

For a man, it can be very disturbing to have enlarged breasts. However, the development of breast tissues usually doesn’t cause health issues in males.

As emotional aspects are not considered by insurance companies when offering coverage for a specific disease or treatment, patients usually don’t get a claim approval for male breast reduction surgery.

A patient needs to match specific criteria to get the surgery covered by health insurance or mediclaim. The criteria include-

The patient should have both glandular tissues and fat tissues or only glandular tissue growth. If the patient has pseudogynecomastia (only fat tissues), the surgery is considered cosmetic in nature.
The patient must be an adult and have had the condition for 2 years or longer.
The condition has reached grades II, III, or IV.
The increased size of the breasts is causing pain, discomfort, posture issues, etc.
The patient has discontinued the drugs or medicines that induced hormonal imbalance in the first place and led to gynecomastia.
The condition persisted despite addressing the underlying cause.
The enlargement is caused due to Klinefelter Syndrome.
The tissue growth is cancerous.

In all these above-mentioned scenarios, patients can get approval from health insurance providers easily and get the best quality treatment without worrying about the cost.

• Disease name

Enlarged Male Breasts (Man boobs)

• Surgery name

Gynecomastia (Male Breast Reduction Surgery)

• Duration

1 - 2 Hours

• Treated by

Plastic surgeon

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List of Top Health Provider for Gynecomastia

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Aditya Birla Health Insurance Co. Ltd.

National Insurance Co. Ltd.

Bajaj Allianz General Insurance Co. Ltd.

Bharti AXA General Insurance Co. Ltd.

Future General India Insurance Co. Ltd.

HDFC ERGO General Insurance Co. Ltd.

How to get Gynecomastia Surgery under Insurance?

1 Intimation

Fill up the pre-auth form at the network hospital for cashless approval. Fill up the pre-auth form at the network hospital for cashless approval

2 Approval/Rejection

Fill up the pre-auth form at the network hospital for cashless approval. Fill up the pre-auth form at the network hospital for cashless approval

3 Hospitalisation

Hospitalisation can be done on the basis of pre-auth approvalHospitalisation can be done on the basis of pre-auth approval

4 Claim Settlement

At the time of discharge, we settle the claim directly with hospitalAt the time of discharge, we settle the claim directly with hospital

1 Hospitalization At Non Network Hospital

You need to pay the bills initially and preserve the original invoices

2 Register A Claim

Post hospital discharge send us all your invoices and treatment documents

3 Verification

We verify your claim related invoices and treatment documents

4 Claim Settlement

We send the approved claim amount to your bank account

Best Doctors for Gynecomastia

Dr. Rohit Devdutt Bavdek...

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Dr. Devidutta Mohanty

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Dr. Abhinandan Sampathra...

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Expenses of Gynecomastia Surgery That Are Covered by Health Insurance

Depending on the plan purchased, the expenses covered by health insurance for gynecomastia surgery may vary. Overall, the following expenses can be covered-

The doctor’s consultation and operating fee
The anesthesia and anesthetist’s fee
Diagnostic tests and evaluations done before and after the surgery
Hospital admission and discharge fee
OT and ICU charges
Room rent (single, double, or sharing) on a daily basis
Medicines given to the patient during the hospital stay
Medical consumables, such as syringes, sutures, staples, catheters, gloves, masks, adhesives, dressing, etc.
Post-surgery follow-up consultations

In most cases, the coverage of health insurance policies can be customized to get add-on covers to ensure that all aspects of the treatment can be covered by insurance.

All Major Insurances Accepted

Waiting Period to Get Gynecomastia Surgery Covered by Insurance

A waiting period, also known as the cooling period, is a pre-decided time span, post which, a specific list of diseases or ailments can be covered by the health insurance policy. The waiting period clause is given in all policies for base coverage to ensure that people don’t purchase the policy solely to get coverage for a particular treatment.

In most insurance plans, the minimum waiting period to get an insurance claim for gynecomastia treatment is 2 years.

Pristyn Care’s Free Post-Operative Care

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FAQs Related to Gynecomastia Insurance Coverage

When is gynecomastia surgery not covered by health insurance?

Gynecomastia surgery is not covered by insurance in the following cases- The surgery is being performed solely to improve the appearance of the chest region. The patient is more inclined toward surgery to address psychological and psychosocial concerns.

What expenses are not covered by health insurance?

The health insurance policy won’t cover the following aspects of gynecomastia surgery- Follow-up consultations with the doctor Diagnostic tests performed during follow-ups (if any) Compression garments Prescribed medications and refills

How much does gynecomastia surgery cost in India?

On average, gynecomastia surgery cost in India ranges from Rs. 38,000 to Rs. 70,000. This is an estimated cost range and the actual cost of the treatment varies for each patient due to various factors.

What factors affect male breast reduction surgery cost?

The key factors that affect the cost of male breast reduction surgery include- The grade of gynecomastia Technique used Surgeon’s fee Anesthesia fee Hospital-related expenses Post-surgery care

How can I avail No-Cost EMI service at Pristyn Care?

To get approval for No-Cost EMI service, the patients need to take the following steps- Apply for the No-Cost EMI service by making a request to the care coordinators. Provide the necessary documents to check whether you are eligible for the service. When approved, choose a tenure to pay the monthly installments. Undergo surgery without worrying about the expenses. Our care coordinators assist the patients with the approval process thoroughly.

Undergo Gynecomastia Surgery With or Without Insurance at Pristyn Care

At Pristyn Care, we provide advanced treatment for gynecomastia for medical and cosmetic purposes. So, whether the patient has insurance or not, he/she won’t have to worry about the expenses.

We accept all major health insurance policies and provide assistance to patients with paperwork and the claim process. Our care coordinators explain all terms and conditions and clauses (co-pay, sub-limits, waiting period, etc.) of the insurance policy for a better understanding of the patients. We provide cashless service for gynecomastia surgery and ensure that the claim settlement is done as early as possible.

Avail No-Cost EMI for Gynecomastia Surgery

If a patient doesn’t have health insurance, we also provide them multiple payment options, including credit card, debit card, cheque, and No-Cost EMI service.

The No-Cost EMI service is offered to all patients. It is a very beneficial service for patients who wish to get immediate treatment but doesn’t have sufficient funds. The service allows the patients to divide the treatment expense into easily payable monthly installments.