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Man who requires breast surgery denied coverage by insurance company.


Insurance companies' refusal to cover breast surgery for men is at issue after an Indian male expatriate's request was declined despite doctor's orders to undergo the procedure.

Citing the surgery as cosmetic, the insurance company refused to cover the surgery.

On the other hand, a leading breast surgeon and specialist plastic surgeon has said that gynaecomastia, an abnormal enlargement of breast tissue in males, should be covered by insurance as the condition carries a risk of breast cancer and has debilitating psychological symptoms.

The 26-year-old patient Shah Khan, a software developer, contacted Gulf News. He said he was diagnosed with severe gynaecomastia, and his doctor asked him to undergo surgery. He claimed he had taken up the coverage refusal with his insurance provider twice, but was refused.

According to Khan's medical report, he has tenderness in the breast and nipple discharge. He requires excision (removal) and histopathology (study of changes in tissues caused by disease). The procedure requires a two-day stay with post-operative visits.

Khan said, "I have been suffering since my college days. In the last six months the pain increased, and I got a medical diagnosis a few weeks ago. My social life has been at a standstill and work is suffering as well."

As a married man, he said that his wife has been supportive. "However, I am unable to face the society. I am ridiculed. The surgery costs around Dh15,000, which I cannot afford."

Khan's insurance company told Gulf News that the matter is between the client and the provider, and declined to comment.

According to Dr Zahrah Rafaei, a specialist plastic surgeon in breast reconstruction, from Rashid Hospital, Dubai, surgery to treat gynaecomastia should be covered by insurance providers.

She said enlarged breast tissue carries a risk of breast cancer in men. "Further, gynaecomastia causes severe psychological problems affecting social and married life."

Dr Rafaei explained, "Even though breast cancer in men represents less than one per cent of all breast cancer cases, enlarged breast tissue is a concern. Breasts in men can get enlarged due to medication, hormone imbalance, heavy alcohol consumption and/or weight gain."

She estimates that due to high levels of obesity in the Middle East, the incidence of gynaecomastia is higher compared to Europe.

Posing as a customer, Gulf News attempted to find out whether gynaecomastia is covered by insurance providers.

At Axa, gynaecomastia is listed under general policy exclusion, and no concession is given even in severe cases.

At Oman Insurance, the condition is not covered as it comes under cosmetic/plastic surgeries.

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Publication:Gulf News (United Arab Emirates)
Date:Aug 12, 2013
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