how can our young boys grow up to be men if they are taunted about their man-boobs daily? I know what it is like to suffer from poor self-image, it took me years to overcome all the taunts I received as a child. This insurer should be glad they escaped only owing 5,000.00.
Yes, but where does it stop? I know really great people who have been taunted just because they weren\’t beautiful and it has really hindered their lives.
In my opinion, if it weren\’t for medical reasons, insurance shouldn\’t cover it. I have too much testosterone in my system and hair grows like wildfire on my face. Do you know how embarassing that is? But insurance won\’t cover it for me to have it permanently removed. What\’s the difference between me and tits mcgee here?
But back to the topic. The article didn\’t go into detail, but I don\’t believe this condition typically occurs in people who are not overweight. I could be wrong, but I don\’t see… boobies… (God bless you, Smarty!!!) on skinny, in-shape people. The kid was probably fat. I see lots of… boobies… on fat young boys far too often today. How about they put down the fork, get up off their fat behinds and get some exercise. Sorry, kid. You filled your bra, you wear it!
Exactly what I was thinking. I wish the article had included more detail about his size. I hate to say it, but that was the mental picture I got, that he is overweight. Even women with larger than usual breast size are asked to try losing weight before they will do the surgery to see if that causes a change in breast size to occur. It shows you how much our society is changing.
You know this kid must come from money if they have enough time and money to take an insurance company to court for this. it wasn\’t life threatening so why did they have to cover it. You know I’m a little pudgy i could use some liposuction. My friends tease me about being fat.
I ask you though? Whats more embarrassing getting teased about man-boobs or having an article put over the web for thousands of strangers to read about your court case on man-boobs. He could probably get a spot on that stupid show Jackass on MTV!!
Just out of curiosity? What size cup did he have/get reduced to? HAHA. Boobies!
I appreciate your comments Amazed, but comparing this to reconstructive surgery AFTER a masectomy is RIDICULOUS. How do boobs affect the quality of someone\’s life? it\’s not life endangering is it? it doesn\’t mean the kid can\’t go outside (he CHOSE not to). that\’s why I am baffled by this. Women don\’t choose to have breast cancer.
And for assuming that this kid may have been overweight, is a fair assumption. If it\’s a wrong one, then it\’s wrong, but you can\’t tell me it\’s far off the mark.
It just goes to show you it really is a man\’s world.
I hope Claudia never has to deal with a personal condition that will make her
\”choose\” not to go out. Walk a mile in his shoes & see how it fits. Granted we all may assume he is overweight, but who are we to judge. Besides, you know what assume stands for.
This condition is not caused by weight, it is caused by hormones. I have a 6\’ 2\”, 160lb son that has this issue and it is only on one side. It is not a weight issue, it is a hormone issue and normally goes away by the time they complete puberty. In the instantances where is does not go away there may be a call for the medical insurance companies to take another look at the way they consider the claim if it is property diagnosed. Please take the time to look this condition up on Yahoo health or Google it before casting judgement.
The problem was not that the kid was ridiculed it was that he\’s a teenager with breasts and the parents can\’t get him to leave his room.
Seriously, this should not be covered if it\’s a matter of making someone \”feel better\” about themselves. There are any number of things that people are ridiculed for that are not covered.
I agree that a national news story is much more humiliating than the teasing he might get.
Hello – read my earlier comments. do you know how many men find it attractive that I have hair on my chin and that i shave regularly just like they do? Do you know how embarassing it is to explain that, when they notice or feel the stuble i have EVERY DAY? I have gone to my doctor, my dermatologist, etc…but, because i have a high testosterone level, insurance won\’t cover me to have permanent hair removal laser surgery (even if I were diagnosed with polycystic ovarian syndrome, i would still have to have my doctor write a letter BEGGING the insurance company to give me permission to have the laser surgery). But i don\’t let that slow me down. i take care of it on a daily basis, and do the best i can with the fact that you can obviously see the stuble on my entire chin and some on my cheek. i have no intentions of suing, just wait patiently until i have enough money to solve the problem MYSELF. Thank you.
Have you ever seen the Simpsons episode…when Homer sees the German kid in the bathroom and yells,
\”Hey that kid has boobies, hehehe\” then chases him around the lockeroom wipping the naked kid with the towel? Freakin hilarious.
Anyways that\’s what popped into my head when I read this. Cheers
It should be covered at least up to a certain age. I couldn\’t imagine having to deal with this as a young man, all to say the ins co a few thousand $$, more than they lost in legal fees AND pr.
Ignorance…because you know so much about me…because you have your own personal problems? Please…your or my own personal issues with this topic aside, you can not argue the number of children who are obese in our society. Sorry you have hair on your chin…but really your own issues have nothing to do with this article.
The whole question is wether or not this is a medically necessary procedure. That is what the insurance policy agrees to cover. Feelings and lets just pay this one so we wont look bad are not good criteria on which to pay a claim. I hate this for the boy, but the policy should cover what it is designed to and both parties agreed to. The buyer knows or at least has the info when they sign up on what the policy does and does not pay for.
Mike you just proved my point. You addressed two different issues under one s/n. Claudia talked about her condition not I, I am the one that said you were ignorant. Congrats… Here\’s your sign.
\”The buyer knows or at least has the info when they sign up on what the policy does and does not pay for.\”
I disagree slightly on this point. When was the last time you saw a health insurance policy with a column of included diseases and a column of excluded diseases? It is definitely not as straightforward as a homeowners or auto policy. It might state that medically necessary surgeries are covered (obviously) and cosmetic surgeries are not (obviously). But, does it really break it down disease by disease?
Cancer- covered
Muscular Dystrophy- Covered
Bilateral Gynecomastia- Not covered
I am not saying it should or should not be covered. I am just saying your policy doesn\’t list by diseases. It then becomes a matter of each side trying to prove their case.
Personally, I am going back and forth on my opinion. You are arguing some good points everyone.
For those who made fun of me or missed my point, let me try again. I\’m saying my condition could be considered a similar situation to this young man\’s. But, since my insurance company has rejected me (and many other women), instead of suing, i\’m going to work hard and pay for the surgery myself. (and thanks for the waxing option, but that doesn\’t \”cure\” the problem, and is pretty expensive itself. if i saved that money instead of going to the salon to wax it, i could have money saved up to just do the laser surgery). I\’m not mad at anyone for my condition, and while it is noticeable if you look closely, and it is embarassing, I don\’t want a dang hand-out. This condition doesn\’t prevent me from doing anything nor will it shorten my life expectancy. THAT is what i\’m saying about this young man. embarassing as it may be, at whatever age, it DOES NOT hinder his life, ERGO, should not be covered by insurance.
This is ridiculous. Maybe I have a big nose and a small chest. I feel very picked upon in today\’s society. Waaa waaa, boo hoo….. I want my insurer to fix this for me.
Let\’s get serious. It\’s not my health insurer\’s responsibility to pick up the tab if I\’m too insecure to deal with these issues. And to the person who gave an example of a masectomy….last time I checked, cancer was a medical issue…
Amazed, I\’m simply amazed by your only point on this. So your arguing this as a mental health issue because it adversely affects others? How is this the case? Are you implying that anyone overweight is unhappy? That people with man-boobs have lower quality of lives?
The question as Danny put it refers back to whether or not this should be covered by the insurance carrier. Let me pose a question, had this been not man boobs but someone who lost so much weight that their skin was in flaps, or if this were a girl with a low self esteem about the size of her breasts…would this make a difference?
It does hinder the quality of this boys\’ life drastically. As far as the reconstructive surgery, breasts are breasts- they arent gender specific- so are we saying now we are discriminating that because women are used to having them that they can have them reconstructed, but men cant?
Reconstructed because of cancer is not the same as reconstructed because you are embarassed. Reconstructed because of severe back pain and can\’t function daily is not the same because you can\’t be on the \”skins\” team in a game of pick-up basketball.
Then perhaps the school has some liability in this?
I don\’t think the insurer should have paid for the surgery. But maybe some therapy is in order, if his policy will cover it…
There\’s teasing, then there\’s hazing. Both are similar, but definitely not the same.
I assume various horrors were probably visited upon this kid by his peers. The school owes it to the child to make sure he is in a safe environment. If they failed to do that, there\’s a problem.
That doesn\’t necessarily mean the boy and his family are due a huge settlement, but if the schools failure to protect him from hazing has caused him emotional/mental harm, the school (or school\’s insurer) probably needs to help pay for some of that kid\’s counseling.
I didn\’t miss your point the first time or the time after, etc. ;) I think I am swaying to your side. I mean, if the condition was life threatening, I am sure you would agree it should have been paid for. It doesn\’t SEEM* to be, so it shouldn\’t. Excellent point!
Thank you =)
*If there are facts not entered into evidence which make this disease life threatening, by all means, the ins. co. should pay for the surgery.
If it makes you feel better, I think your posts on the dog food thread were the most well written. I saw how people ignored your points, but consider the sources. Some people were trying to be funny, others were obnoxious. You were very serious in your posts. It was a very serious topic to you. I am not a pet person by any means. I don\’t understand firsthand how people view pets as their children. However, since I don\’t know how that feels (to be so attached) I would never even think to say that it doesn\’t feel the same to lose a pet as it does to lose a child. Cheers to you for being sensible and not sinking down to their level!
Ok since very few have acctually looked up this condition, let me share with you the other possibilities this condition brings:
Persistent pubertal gynecomastia — 25%
Cirrhosis or malnutrition — 8%
Primary hypogonadism — 8%
*****Testicular tumors — 3%****
Hyperthyroidism – 1.5%
Now does that satisfy those of you who still question if this is a medical issue or no?
And swaying back. :) You think Claudia\’s condition should be covered too, right? So many posts, I don\’t want to check back through.
Glad I am not the one who has to decide this one! I guess the argument was that it was cosmetic surgery. Technically, it was, wasn\’t it? But, on the flip side…
OK, it\’s good not to be in the health insurance business :)
Yes, Jewel, if this were a life threatening case, (and not just something that goes against the social norm), I would TOTALLY agree with this surgery. I do feel badly for the kid, but that doesn\’t mean exceptions should be made because someone is embarassed. I feel the same way about women who have breast augmentation to enlarge their breasts purely for asthetic reasons.
Bilateral gynecomastia refers to the benign enlargement of the male breast, either due to increased adipose tissue, fibrous tissue, or a combination of all three.
Concepts of medical necessity are based on the presence of a functional impairment. Typically no functional impairment is associated with gynecomastia. Therefore, determination of coverage eligibility for the surgical treatment of bilateral gynecomastia may require consideration of whether or not such sugery would be considered either essentially cosmetic in nature or reconstructive. (See policy Surgery No. 12 for further discussion of functional impairment, and general concepts of reconstructive and cosmetic services.) Contractual definitions of the scope of reconstructive services that may be eligible for coverage vary.
you know amazed, you spouted your mouth off, too. so your heroic attitude is for not. anyone who has taken any sort of sex education class (or even high school biology) would know this is just one of the \”dang, that\’s unfortunate\” conditions, not a life threatening one.
There are a lot of conditions that are not life threatening by them selves, that are covered under a medical insurance; tonsillitis, common cold, but they may become that way if not prevented or taken care of with medical attention. This particular condition, if properly diagnosed, may have other more serious medical implications than just the presence of breasts on a male, as Amazed had found in reveiwing the condition. The medical community is finding out that there is more to it than just \”Unfortunate Condition\” as we were taught in school.
And you received your medical degree from???? I stated my opinion based upon medical information that I gleened from the research I did. In addition to the 20 plus years I have in the insurance industry working as an MGA who handles medical malpractice insurance. Lisa also presented an educated researched arguement. You touted your chin condition. Now tell me Claudia, who made the more educated arguement?
I maynot concur with Lisa, however I do respect her opinion.
On a personal note- I do feel your condition has adversely effected your ability to harbor an unbias opinion. Does your insurance cover attitude adjustments?
Amazed didn\’t come up with that, Lisa did. And my condition may not be life threatening now, but I have been told good luck having children, etc… but again, I\’m not suing my insurance company over it. I also have arthritis, i\’m a degenerate, as most insurance companies call me, but again, I won\’t sue anyone when i\’m rolling down a hill in my wheelchair one day. I appreciate what you and Amazed are saying, it\’s a great debate, but I am not convinced this was nothing more than cosmetic surgery.
And you know what else, I have taken a lot of shots today, but you know what Amazed, i listened with a grain of salt and have yet to suggest you have an attitude adjustment…thanks for your open mindedness.
National Health will end the appetite of the American people that think everything under the sun is a medical reason.
The Nationalized plans of most countries are quite strict about what is medical and what is elective.
People whine and complain now, Wait until they get what they want…Nationalized medicine. Then who will they B and whine to?
I don\’t know if I had the condition but until I was 13 (54 years old now) I had big boobs. Why? Because I was a fat boy. I got tired of being fat, told my parents I no longer ate white bread, butter, salt, etc., I started lifting weights and I haven\’t been fat for over forty years. Traded in my man boobs for pectorial muscles. When I was a fat boy with boobs I did get taunted. I wonder if the kid just needed a little bit of exercise?
Exactly, LLP. For instance, when I was a young teenager, I had terrible acne. Was it life threatening? Of course not. Was it embarassing? Most decidedly. It was by no means medically necessary to treat, yet my insurance still paid for me to see a dermatologist and use several different perscriptions over a period of time. Should this all have been paid for?
Hah! Glad my \”candor\” was entertaining, Hey now!
I tried your number, but it didn\’t work. (I am also a blonde).
There is no \”I\” missing from my initials — \”MLF\” is the employee number given me by my employer. It goes on every single insurance document I process. Boy, do I get teased. However, the initals hold merit — I actually AM a quite attractive mother of three boys. (And that has nothing to do with the implants).
A blonde hottie in the insurance world? Damn, some employers have all the luck… I\’ve been searching for someone like you…intelligent, humorous AND attractive since I\’ve been a boss. How much they paying you??
Kidding aside, the responses to this article I find rather inane. To me the implications of the ruling seem far more interesting than this particular individual procedure. Will this ruling change the policy language? Where will the line between cosmetic surgery and medically recommended surgeries NOW be drawn? Perhaps breast augmentation and various laser surgeries will soon be recognized as needed procedures due to the mental anguish associated with the social stigma involved… stay tuned… maybe I can finally get my carrier to pay for the lipo I\’ve wanted to rid me of that incessant inch around my belly that pays no mind to the endless sit-ups!
The fact remains that this is a cosmetic procedure; however, later in ones life bilateral gynecomastia can cause pain thus warranting legitimate medical claim. Until that fact ensues, the only need for this surgery is due to self-esteem and to change ones appearance due to self-esteem is purely cosmetic. Now let us think logically not emotionally when dealing with this issue. If surgeries where the only ailment is self-esteem are covered by insurers, how many people will take advantage and correct everything that one finds unpleasant to the eye? To counteract that increase, insurers would raise premiums by a substantial amount (due to the high costs of plastic surgery). Now that I have shown the cost will be absolved by \”YOU\” and everyone else (regardless of you electing to have one of these procedures or not), How do you feel about the issue now?
I know that many people will ask, \”but Ross where is your compassion?\” I will respond with two things. First, I have no compassion. Second, if I did have compassion it would go to those who are in need of medical intervention or they die. My compassion also goes to those that will no longer be able to afford coverage, due to the substantial increase in premium. Also an increase in uninsureds will also lead to an increase in hospital costs. Even if you don\’t have insurance hospitals are obligated by law to stabilize you and the cost gets passed on to those that can pay (AKA insurers, who will then pass the costs to you…Again).
In conclusion, I am asking that people think before act. Every action has an equal and opposite reaction. Before you act you must know and understand the reaction, if that is too hard for you then you have no say on the action.
I have had to wear thick glasses ever since I was 7 years old because of extreme nearsightedness. Think of all the humiliation I endured throughout school. If this precedent holds, my kids should be able to get laser surgery on their eyes paid for by my health insurance because that will prevent the self-esteem issues of growing up with glasses!
My son, 12, has large breasts. He is also overweight. He could have liposuction removing fat but it would not cure the underlying problem which is an abnormal amount of tissue. I underwent liposuction of my chest as a conservative approach to the same problem. It was not the answer for which I had hoped. I will undergo tissue removal now because I still have boobs and pain in both sides. (Plus, one side is larger than the other.)
There is no question that the condition adversely affects my son\’s mental and physical health. In large part, because of the teasing (which I have personally witnessed), he is less likely to swim, play tennis, etc. This only compounds the weight issue which does make the condition appear worse.
Our hearts ache for him and while we were delaying surgical considerations for him until he was just a few years older and possibly trimmer, we fear it shouldn\’t wait any longer.
We could afford the surgery for him without insurance coverage. For those who cannot and continue to suffer, I think the court\’s decision is proper. I appreciate the question of line-drawing: where should covered treatment begin and end? Firsthand, I know this is a real condition caused by genetic and hormonal imbalances. I know it has real health ramifications that by covered surgery can be cured and even prevented. It should be covered.
Many of the postings here are insensitive. They are not unlike what my son endures on a daily basis. If you one day meet my son or someone like him, I hope you\’ll be considerate and more understanding.
There was a boy who must have had this condition when I attended high school. I found myself next to him one day in the gym shower room and I remember being amazed by his appearance and feeling somewhat uncomfortable. Luckily, we were a good bunch of kids and no one teased him but I still think anyone in that condition should be covered.
This is why people have such negative impressions of insurers. All that fighting in courts for $5000. Just pay for the dam n surgery!
how can our young boys grow up to be men if they are taunted about their man-boobs daily? I know what it is like to suffer from poor self-image, it took me years to overcome all the taunts I received as a child. This insurer should be glad they escaped only owing 5,000.00.
Yes, but where does it stop? I know really great people who have been taunted just because they weren\’t beautiful and it has really hindered their lives.
In my opinion, if it weren\’t for medical reasons, insurance shouldn\’t cover it. I have too much testosterone in my system and hair grows like wildfire on my face. Do you know how embarassing that is? But insurance won\’t cover it for me to have it permanently removed. What\’s the difference between me and tits mcgee here?
Smarty,
That was hillarious!!!!!!!!!!!!
But back to the topic. The article didn\’t go into detail, but I don\’t believe this condition typically occurs in people who are not overweight. I could be wrong, but I don\’t see… boobies… (God bless you, Smarty!!!) on skinny, in-shape people. The kid was probably fat. I see lots of… boobies… on fat young boys far too often today. How about they put down the fork, get up off their fat behinds and get some exercise. Sorry, kid. You filled your bra, you wear it!
Exactly what I was thinking. I wish the article had included more detail about his size. I hate to say it, but that was the mental picture I got, that he is overweight. Even women with larger than usual breast size are asked to try losing weight before they will do the surgery to see if that causes a change in breast size to occur. It shows you how much our society is changing.
You know this kid must come from money if they have enough time and money to take an insurance company to court for this. it wasn\’t life threatening so why did they have to cover it. You know I’m a little pudgy i could use some liposuction. My friends tease me about being fat.
I ask you though? Whats more embarrassing getting teased about man-boobs or having an article put over the web for thousands of strangers to read about your court case on man-boobs. He could probably get a spot on that stupid show Jackass on MTV!!
Just out of curiosity? What size cup did he have/get reduced to? HAHA. Boobies!
Yes it should have been covered as it is a medical condition adversly effecting the quality of life of the people involved.
If anyone had even looked up the medical term that is listed then you would have seen before and after pictures of the men this effects.
Boys and girls most of the men effected were not overweight. One 16 year old only had one \”breast\” enlarged.
This should be treated as reconstructive surgery after a Mastectomy, unless you are calling that just cosmetic too.
OMG and \”boobies\” geez grow up people,you might want to put mind in gear, before putting fingers in motion.
I appreciate your comments Amazed, but comparing this to reconstructive surgery AFTER a masectomy is RIDICULOUS. How do boobs affect the quality of someone\’s life? it\’s not life endangering is it? it doesn\’t mean the kid can\’t go outside (he CHOSE not to). that\’s why I am baffled by this. Women don\’t choose to have breast cancer.
And for assuming that this kid may have been overweight, is a fair assumption. If it\’s a wrong one, then it\’s wrong, but you can\’t tell me it\’s far off the mark.
It just goes to show you it really is a man\’s world.
I hope Claudia never has to deal with a personal condition that will make her
\”choose\” not to go out. Walk a mile in his shoes & see how it fits. Granted we all may assume he is overweight, but who are we to judge. Besides, you know what assume stands for.
This condition is not caused by weight, it is caused by hormones. I have a 6\’ 2\”, 160lb son that has this issue and it is only on one side. It is not a weight issue, it is a hormone issue and normally goes away by the time they complete puberty. In the instantances where is does not go away there may be a call for the medical insurance companies to take another look at the way they consider the claim if it is property diagnosed. Please take the time to look this condition up on Yahoo health or Google it before casting judgement.
The problem was not that the kid was ridiculed it was that he\’s a teenager with breasts and the parents can\’t get him to leave his room.
Seriously, this should not be covered if it\’s a matter of making someone \”feel better\” about themselves. There are any number of things that people are ridiculed for that are not covered.
I agree that a national news story is much more humiliating than the teasing he might get.
Hello – read my earlier comments. do you know how many men find it attractive that I have hair on my chin and that i shave regularly just like they do? Do you know how embarassing it is to explain that, when they notice or feel the stuble i have EVERY DAY? I have gone to my doctor, my dermatologist, etc…but, because i have a high testosterone level, insurance won\’t cover me to have permanent hair removal laser surgery (even if I were diagnosed with polycystic ovarian syndrome, i would still have to have my doctor write a letter BEGGING the insurance company to give me permission to have the laser surgery). But i don\’t let that slow me down. i take care of it on a daily basis, and do the best i can with the fact that you can obviously see the stuble on my entire chin and some on my cheek. i have no intentions of suing, just wait patiently until i have enough money to solve the problem MYSELF. Thank you.
Have you ever seen the Simpsons episode…when Homer sees the German kid in the bathroom and yells,
\”Hey that kid has boobies, hehehe\” then chases him around the lockeroom wipping the naked kid with the towel? Freakin hilarious.
Anyways that\’s what popped into my head when I read this. Cheers
It should be covered at least up to a certain age. I couldn\’t imagine having to deal with this as a young man, all to say the ins co a few thousand $$, more than they lost in legal fees AND pr.
Will Blue Cross pay for johnson reduction surgery? I sure hope so.
How about instead of suing and taking months to get the verdict in courts, the kid hits the gym and eats a bit more lettuce?
Then you of all people should understand- Bilateral Gynecomastia is a medical condition just like yours is-
Ever thought of waxing?
Agreed since this condition usually is in boys under the age of 18
Well they could at least refer you to Mrs. Bobbit
Since ignorance is bliss- you should be a very, very happy person… huh?
Ignorance…because you know so much about me…because you have your own personal problems? Please…your or my own personal issues with this topic aside, you can not argue the number of children who are obese in our society. Sorry you have hair on your chin…but really your own issues have nothing to do with this article.
The whole question is wether or not this is a medically necessary procedure. That is what the insurance policy agrees to cover. Feelings and lets just pay this one so we wont look bad are not good criteria on which to pay a claim. I hate this for the boy, but the policy should cover what it is designed to and both parties agreed to. The buyer knows or at least has the info when they sign up on what the policy does and does not pay for.
Danny I couldn\’t agree more with you. Well said
Let\’s not give Claudia a hard time. Props to her for accepting her situation and not looking for someone to blame!!!
Mike you just proved my point. You addressed two different issues under one s/n. Claudia talked about her condition not I, I am the one that said you were ignorant. Congrats… Here\’s your sign.
Do you consider mental health a \”medical\” condition? If no we shouldnt need insurance for that should we?
\”The buyer knows or at least has the info when they sign up on what the policy does and does not pay for.\”
I disagree slightly on this point. When was the last time you saw a health insurance policy with a column of included diseases and a column of excluded diseases? It is definitely not as straightforward as a homeowners or auto policy. It might state that medically necessary surgeries are covered (obviously) and cosmetic surgeries are not (obviously). But, does it really break it down disease by disease?
Cancer- covered
Muscular Dystrophy- Covered
Bilateral Gynecomastia- Not covered
I am not saying it should or should not be covered. I am just saying your policy doesn\’t list by diseases. It then becomes a matter of each side trying to prove their case.
Personally, I am going back and forth on my opinion. You are arguing some good points everyone.
Nah- you must have designed this site- it posted 3 times due to a programming glitch.
For those who made fun of me or missed my point, let me try again. I\’m saying my condition could be considered a similar situation to this young man\’s. But, since my insurance company has rejected me (and many other women), instead of suing, i\’m going to work hard and pay for the surgery myself. (and thanks for the waxing option, but that doesn\’t \”cure\” the problem, and is pretty expensive itself. if i saved that money instead of going to the salon to wax it, i could have money saved up to just do the laser surgery). I\’m not mad at anyone for my condition, and while it is noticeable if you look closely, and it is embarassing, I don\’t want a dang hand-out. This condition doesn\’t prevent me from doing anything nor will it shorten my life expectancy. THAT is what i\’m saying about this young man. embarassing as it may be, at whatever age, it DOES NOT hinder his life, ERGO, should not be covered by insurance.
Bravo- an intelligent common sense comment. I dont concur- however bravo you made an excellent point.
This is ridiculous. Maybe I have a big nose and a small chest. I feel very picked upon in today\’s society. Waaa waaa, boo hoo….. I want my insurer to fix this for me.
Let\’s get serious. It\’s not my health insurer\’s responsibility to pick up the tab if I\’m too insecure to deal with these issues. And to the person who gave an example of a masectomy….last time I checked, cancer was a medical issue…
Thank you!
Amazed, I\’m simply amazed by your only point on this. So your arguing this as a mental health issue because it adversely affects others? How is this the case? Are you implying that anyone overweight is unhappy? That people with man-boobs have lower quality of lives?
The question as Danny put it refers back to whether or not this should be covered by the insurance carrier. Let me pose a question, had this been not man boobs but someone who lost so much weight that their skin was in flaps, or if this were a girl with a low self esteem about the size of her breasts…would this make a difference?
Just disagreeing with Claudia\’s comment from 2:08 pm:
\”How do boobs affect the quality of someone\’s life?\”
I have implants, and they have most certainly improved the quality of MY life.
However, I DO agree that it\’s a man\’s world. That\’s why I got the implants.
It does hinder the quality of this boys\’ life drastically. As far as the reconstructive surgery, breasts are breasts- they arent gender specific- so are we saying now we are discriminating that because women are used to having them that they can have them reconstructed, but men cant?
Hmmm….
Thanks for the honesty!
Reconstructed because of cancer is not the same as reconstructed because you are embarassed. Reconstructed because of severe back pain and can\’t function daily is not the same because you can\’t be on the \”skins\” team in a game of pick-up basketball.
Subject: lisa – the voice of reason
Posted On: April 5, 2007, 3:33 pm CDT
Posted By: Claudia
Comment:
Thank you!
Well thanks. I could have used your support in the dog food thread a few days ago. LOL
Then perhaps the school has some liability in this?
I don\’t think the insurer should have paid for the surgery. But maybe some therapy is in order, if his policy will cover it…
There\’s teasing, then there\’s hazing. Both are similar, but definitely not the same.
I assume various horrors were probably visited upon this kid by his peers. The school owes it to the child to make sure he is in a safe environment. If they failed to do that, there\’s a problem.
That doesn\’t necessarily mean the boy and his family are due a huge settlement, but if the schools failure to protect him from hazing has caused him emotional/mental harm, the school (or school\’s insurer) probably needs to help pay for some of that kid\’s counseling.
Claudia-
I didn\’t miss your point the first time or the time after, etc. ;) I think I am swaying to your side. I mean, if the condition was life threatening, I am sure you would agree it should have been paid for. It doesn\’t SEEM* to be, so it shouldn\’t. Excellent point!
Thank you =)
*If there are facts not entered into evidence which make this disease life threatening, by all means, the ins. co. should pay for the surgery.
If it makes you feel better, I think your posts on the dog food thread were the most well written. I saw how people ignored your points, but consider the sources. Some people were trying to be funny, others were obnoxious. You were very serious in your posts. It was a very serious topic to you. I am not a pet person by any means. I don\’t understand firsthand how people view pets as their children. However, since I don\’t know how that feels (to be so attached) I would never even think to say that it doesn\’t feel the same to lose a pet as it does to lose a child. Cheers to you for being sensible and not sinking down to their level!
Ok since very few have acctually looked up this condition, let me share with you the other possibilities this condition brings:
Persistent pubertal gynecomastia — 25%
Cirrhosis or malnutrition — 8%
Primary hypogonadism — 8%
*****Testicular tumors — 3%****
Hyperthyroidism – 1.5%
Now does that satisfy those of you who still question if this is a medical issue or no?
Amazed-
And swaying back. :) You think Claudia\’s condition should be covered too, right? So many posts, I don\’t want to check back through.
Glad I am not the one who has to decide this one! I guess the argument was that it was cosmetic surgery. Technically, it was, wasn\’t it? But, on the flip side…
OK, it\’s good not to be in the health insurance business :)
Yes, Jewel, if this were a life threatening case, (and not just something that goes against the social norm), I would TOTALLY agree with this surgery. I do feel badly for the kid, but that doesn\’t mean exceptions should be made because someone is embarassed. I feel the same way about women who have breast augmentation to enlarge their breasts purely for asthetic reasons.
Hmmmm…Amazed….this is what I found….
Description
Bilateral gynecomastia refers to the benign enlargement of the male breast, either due to increased adipose tissue, fibrous tissue, or a combination of all three.
Concepts of medical necessity are based on the presence of a functional impairment. Typically no functional impairment is associated with gynecomastia. Therefore, determination of coverage eligibility for the surgical treatment of bilateral gynecomastia may require consideration of whether or not such sugery would be considered either essentially cosmetic in nature or reconstructive. (See policy Surgery No. 12 for further discussion of functional impairment, and general concepts of reconstructive and cosmetic services.) Contractual definitions of the scope of reconstructive services that may be eligible for coverage vary.
Lisa, it\’s a pleasure to have a debate with a person who is willing to educate themselves before shooting their fingers off.
:o)
I commend both of you. That is what I was trying to relay earlier. There is a need to review and research things before we judge.
Please, it only takes common sense to know boobs aren\’t life threatening.
you know amazed, you spouted your mouth off, too. so your heroic attitude is for not. anyone who has taken any sort of sex education class (or even high school biology) would know this is just one of the \”dang, that\’s unfortunate\” conditions, not a life threatening one.
There are a lot of conditions that are not life threatening by them selves, that are covered under a medical insurance; tonsillitis, common cold, but they may become that way if not prevented or taken care of with medical attention. This particular condition, if properly diagnosed, may have other more serious medical implications than just the presence of breasts on a male, as Amazed had found in reveiwing the condition. The medical community is finding out that there is more to it than just \”Unfortunate Condition\” as we were taught in school.
This is as long as it is properly diagnosed.
And you received your medical degree from???? I stated my opinion based upon medical information that I gleened from the research I did. In addition to the 20 plus years I have in the insurance industry working as an MGA who handles medical malpractice insurance. Lisa also presented an educated researched arguement. You touted your chin condition. Now tell me Claudia, who made the more educated arguement?
I maynot concur with Lisa, however I do respect her opinion.
On a personal note- I do feel your condition has adversely effected your ability to harbor an unbias opinion. Does your insurance cover attitude adjustments?
Amazed didn\’t come up with that, Lisa did. And my condition may not be life threatening now, but I have been told good luck having children, etc… but again, I\’m not suing my insurance company over it. I also have arthritis, i\’m a degenerate, as most insurance companies call me, but again, I won\’t sue anyone when i\’m rolling down a hill in my wheelchair one day. I appreciate what you and Amazed are saying, it\’s a great debate, but I am not convinced this was nothing more than cosmetic surgery.
Most excellent point.
And you know what else, I have taken a lot of shots today, but you know what Amazed, i listened with a grain of salt and have yet to suggest you have an attitude adjustment…thanks for your open mindedness.
National Health will end the appetite of the American people that think everything under the sun is a medical reason.
The Nationalized plans of most countries are quite strict about what is medical and what is elective.
People whine and complain now, Wait until they get what they want…Nationalized medicine. Then who will they B and whine to?
I don\’t know if I had the condition but until I was 13 (54 years old now) I had big boobs. Why? Because I was a fat boy. I got tired of being fat, told my parents I no longer ate white bread, butter, salt, etc., I started lifting weights and I haven\’t been fat for over forty years. Traded in my man boobs for pectorial muscles. When I was a fat boy with boobs I did get taunted. I wonder if the kid just needed a little bit of exercise?
MLF,
I appreciate your honesty on this very touchy subject and am impressed by your candor. How \’bout we get together to further discuss? 555-1234
PS
Are you missing and \”I\” in your initials?
Exactly, LLP. For instance, when I was a young teenager, I had terrible acne. Was it life threatening? Of course not. Was it embarassing? Most decidedly. It was by no means medically necessary to treat, yet my insurance still paid for me to see a dermatologist and use several different perscriptions over a period of time. Should this all have been paid for?
Hah! Glad my \”candor\” was entertaining, Hey now!
I tried your number, but it didn\’t work. (I am also a blonde).
There is no \”I\” missing from my initials — \”MLF\” is the employee number given me by my employer. It goes on every single insurance document I process. Boy, do I get teased. However, the initals hold merit — I actually AM a quite attractive mother of three boys. (And that has nothing to do with the implants).
A blonde hottie in the insurance world? Damn, some employers have all the luck… I\’ve been searching for someone like you…intelligent, humorous AND attractive since I\’ve been a boss. How much they paying you??
Kidding aside, the responses to this article I find rather inane. To me the implications of the ruling seem far more interesting than this particular individual procedure. Will this ruling change the policy language? Where will the line between cosmetic surgery and medically recommended surgeries NOW be drawn? Perhaps breast augmentation and various laser surgeries will soon be recognized as needed procedures due to the mental anguish associated with the social stigma involved… stay tuned… maybe I can finally get my carrier to pay for the lipo I\’ve wanted to rid me of that incessant inch around my belly that pays no mind to the endless sit-ups!
i am not going to read this thread anymore – too much tit for tat going back and forth.
May I suggest AmericanSingles.com….or some really good Employement Practices Liability?
Gosh, sounds like I may need a good lawyer, (good lawyer, now that IS funny) know any cute ones?
how about anabolic steriod use by the teenager? Maybe he just wanted to pump them up some! I\’ll be back!
Might want to read the prior posts and research the medical condition before jumping to an assumption.
The fact remains that this is a cosmetic procedure; however, later in ones life bilateral gynecomastia can cause pain thus warranting legitimate medical claim. Until that fact ensues, the only need for this surgery is due to self-esteem and to change ones appearance due to self-esteem is purely cosmetic. Now let us think logically not emotionally when dealing with this issue. If surgeries where the only ailment is self-esteem are covered by insurers, how many people will take advantage and correct everything that one finds unpleasant to the eye? To counteract that increase, insurers would raise premiums by a substantial amount (due to the high costs of plastic surgery). Now that I have shown the cost will be absolved by \”YOU\” and everyone else (regardless of you electing to have one of these procedures or not), How do you feel about the issue now?
I know that many people will ask, \”but Ross where is your compassion?\” I will respond with two things. First, I have no compassion. Second, if I did have compassion it would go to those who are in need of medical intervention or they die. My compassion also goes to those that will no longer be able to afford coverage, due to the substantial increase in premium. Also an increase in uninsureds will also lead to an increase in hospital costs. Even if you don\’t have insurance hospitals are obligated by law to stabilize you and the cost gets passed on to those that can pay (AKA insurers, who will then pass the costs to you…Again).
In conclusion, I am asking that people think before act. Every action has an equal and opposite reaction. Before you act you must know and understand the reaction, if that is too hard for you then you have no say on the action.
I have had to wear thick glasses ever since I was 7 years old because of extreme nearsightedness. Think of all the humiliation I endured throughout school. If this precedent holds, my kids should be able to get laser surgery on their eyes paid for by my health insurance because that will prevent the self-esteem issues of growing up with glasses!
My son, 12, has large breasts. He is also overweight. He could have liposuction removing fat but it would not cure the underlying problem which is an abnormal amount of tissue. I underwent liposuction of my chest as a conservative approach to the same problem. It was not the answer for which I had hoped. I will undergo tissue removal now because I still have boobs and pain in both sides. (Plus, one side is larger than the other.)
There is no question that the condition adversely affects my son\’s mental and physical health. In large part, because of the teasing (which I have personally witnessed), he is less likely to swim, play tennis, etc. This only compounds the weight issue which does make the condition appear worse.
Our hearts ache for him and while we were delaying surgical considerations for him until he was just a few years older and possibly trimmer, we fear it shouldn\’t wait any longer.
We could afford the surgery for him without insurance coverage. For those who cannot and continue to suffer, I think the court\’s decision is proper. I appreciate the question of line-drawing: where should covered treatment begin and end? Firsthand, I know this is a real condition caused by genetic and hormonal imbalances. I know it has real health ramifications that by covered surgery can be cured and even prevented. It should be covered.
Many of the postings here are insensitive. They are not unlike what my son endures on a daily basis. If you one day meet my son or someone like him, I hope you\’ll be considerate and more understanding.
There was a boy who must have had this condition when I attended high school. I found myself next to him one day in the gym shower room and I remember being amazed by his appearance and feeling somewhat uncomfortable. Luckily, we were a good bunch of kids and no one teased him but I still think anyone in that condition should be covered.