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Insurer must pay for U.S. boy's breast reduction

An insurer must reimburse for a teenage boy’ breast reduction the appeals court ruled. The insurance company refused to pay for the operation on the basis that it was cosmetic surgery.

The Supreme Court's Appellate Division decision upheld two lower court rulings that directed Group Health Inc. (GHI) to pay for the surgery because it was "medically necessary" for the suburban New York boy to lead a normal life.

A GHI spokeswoman said Tuesday she had not seen the decision and could not comment.

In 2004, the then-17-year-old boy's father sued GHI because the insurer refused to pay to reduce the boy's enlarged breasts, a condition known as bilateral gynecomastia. GHI said the surgery was cosmetic and not medically necessary.

Court papers said the teen, of Hempstead, New York, was teased by his peers and never engaged in activities that allowed anyone to see his breasts.

In an earlier ruling, the judge found that the boy was unable to function as a normal adolescent because of his condition.

The judge said the boy's condition was "an objective, tangible and unusual source of turmoil, more akin to a clubfoot or cleft palate than to a large nose, heavy acne or diminutive breasts on an adolescent female, all of which are relatively common."

In upholding earlier rulings, the Appellate Division judges called "absurd" GHI's argument that the plaintiff's claim of emotional distress was not supported by a mental health professional. GHI must pay $5,000 (EUR3,800) to the father who paid for the $7,500 (EUR5,600) surgery out of his own pocket.

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