Insurance Co. Must Cover Boy’s Gynecomastia Surgery
Insurance Co. Must Cover Boy’s Gynecomastia Surgery
April 12, 2007 -
A New York state court of appeals recently ruled that an insurance company must reimburse a teen boy and his father for the cost of a breast reduction surgery to correct a devastating condition known as gynecomastia.
Gynecomastia is a condition marked by abnormally large breasts in men and can have serious psychological and social effects, especially in young boys who are subject to the scrutiny of their peers.
Some insurance companies deny claims seeking coverage for breast reduction surgery to correct gynecomastia, arguing that the surgery is not medically necessary. This was the case of 17-year-old boy whose claim was rejected by Group Health Incorporated.
However, the boy’s father said his son was teased by peers and even considered not going off to college for fear that his dorm-mates would make fun of his condition.
Both the state Supreme Court and the appellate division found in favor of the boy and his father, calling the teen’s breasts a “deformity” and ordering GHI to reimburse the father $5,000 of the $7,500 cost of the breast reduction procedure.
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