American Society of Plastic Surgeons
For Medical Professionals
 
rfederer99
5 months ago
Answered

Insurance Red Flag

Is it a red flag for a plastic surgeon at a UAB (Birmingham, AL) clinic to accept insurance for gynecomastia surgery? Does it mean that the surgeon might be desperate for patients, etc.? Dr. Lebowitz said this to me and I saw it on Dr. Carini's website. Why do you think this is the case?

Procedure: Male Breast Reduction
Type: Question

Replies 4

Karol Gutowski
ASPS Surgeon
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There is nothing wrong with accepting insurance. If a doctor accepts an insurance plan, then they have to accept it for all procedures. However, most insurance plans don't cover it so just because a surgeon accepts insurance, it doesn't mean that insurance will pay for it.

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Debra Johnson
ASPS Surgeon
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Gynecomastia can be a covered procedure of your health insurance if there is truly overdevelopment of male breast tissue (and not just due to obesity). Providing surgery for insured patients is absolutely not a red flag. It means the surgeon is committed to providing services to the community, even though insurance payments do tend to be less than what a plastic surgeon can demand from privately paying customers. Some plastic surgeons do not participate in insurance plans, and only accept patients who pay for their services with cash. This does not make them "better" surgeons, it just means they don't want to hassle with obtaining authorizations from insurers or having to work at an insurance-approved facility. Other plastic surgeons feel a commitment to serving all patients, whether they pay with their own money, their health insurance, or via Medicare/MedicAid. If you find a plastic surgeon you like who accepts your insurance, got for it!

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Nelson Castillo

Thank you for sharing your question. Although i would not consider it a red flag, ultimately the best decision is made based on your comfort level with the surgeon, and examining their before and after work. Hope this helps.

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Tracy McCall
ASPS Surgeon

This is completely not a red flag. Think about it. Why should surgeons force people to pay out of pocket for what their insurance should cover? Gynecomastia excision is sometimes covered by insurance. You examine the patient, then write a letter to the insurance company to see if they will cover it. If they do, great. If they don't cover it, you can pay out of pocket.

What is a red flag is that someone gave you really bad advice. You should think very carefully about taking any more advice from this person.

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