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Insurance Coverage for Transgender Surgery

Written by Dr. Jacobs

The insurance landscape for transgender surgery is changing fast.  If you perform Internet searches on related keywords, you’ll find articles about states beginning to require companies to cover surgery, news on Medicare benefits for transgender individuals and much more.  Even one of the country’s largest insurance companies, Aetna, states that it considers top surgery to be medically necessary when a few conditions are met.

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Nevertheless, we don’t necessarily believe you’ll have an easy time securing insurance benefits for FTM or MTF top surgery.  We are familiar with most of the obstacles, from general discrimination to some companies’ stance that a transgender individual should desire genital surgery in order to be covered for anything else.

In case you’re just getting started researching insurance coverage for transsexual surgery, here are some basics.

Materials to Gather

Before you attempt to secure coverage from your insurance company for male to female or female to male surgery, here are some items that can be helpful or necessary in making the case. 

  • A statement of support from a health care professional.  Do get a letter or other document from your primary care physician, endocrinologist or other qualified medical doctor if at all possible.  If they have prescribed hormones or other measures related to your transition, make sure there’s documentation.
  • A letter of referral from a mental healthcare provider—this is probably a “must.”  It should state that you have persistent “gender dysphoria” meaning that you identify consistently as the gender opposite that of your birth. 
  • Any other supporting material you can think of.  If you have changed your name and been employed under your new name and identity, for instance, evidence to that effect may help.

Resources You Can Check Out

Perhaps the best advice we can give about preparing to engage with your insurance company is to spend some time reading what transgender advocacy groups have to say.  Here are just a few good resources we have found online.

  • WPATH, the World Professional Association for Transgender Health, has a website full of information.  If you haven’t already done so, you might consider bookmarking it.  Be sure to check out the organization’s Statement of Medical Necessity.  This piece outlines very clearly the role of transgender surgery in helping MTF and FTM citizens lead healthy, productive lives.
  • The Human Rights Campaign, a group that works on LGBT rights in a broad sense, has a web page offering a variety of relevant information for transgender people, from its Corporate Equality Index to Maps of State Laws and Policies.  Find the HRC’s overview page here.

How We Can Help

We can’t accept insurance as payment for transgender surgery in New York, in fact, we don’t accept insurance coverage for any plastic surgery procedure.  We are like most plastic surgery practices in this regard.  One leading reason is that few typical patients are successful in convincing their carriers to help pay for what are mainly considered “cosmetic” procedures.

Ironically, as a transgender individual you may have a better chance of securing benefits than most of our other patients.  Since the country is gradually coming around to understanding that MFT and FTM surgery can be medically necessary for many, insurance companies are starting to change their policies.

We absolutely do want to help as much as we can.  First, when you’re ready to come in for a consultation, we can document our findings and create a surgical plan that meets your needs.  This may help you in discussions with your insurance company.  If you haven’t spoken with your carrier yet, we can work with you on your strategy.

Second, we will be very pleased to submit a claim for you after surgery.  Our staff has been doing this for years, and we’re adept at submitting complete and persuasive claims.  If you are denied coverage, we can talk with you about appealing the decision.

Call us at 212-570-6080 or contact us online to begin.  No matter where you stand in thinking about surgery, we’re sure a discussion will assist you.  We look forward to talking with you!

Photo by Christian Schnettelker

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Plastic Surgery Manhattan - Dr. Elliot W. Jacobs, M.D. specializes in Breast Augmentation, Liposuction, Rhinoplasty and other Plastic Surgery procedures serving Manhattan, New York City and the surrounding area. Phone: (212) 570-6080

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