Some of the most stressful questions arise when trying to figure out insurance coverage for gender confirming surgery. You’re not alone if you’re looking at your Google search history and see:
We’re here to provide some guidelines to help answer some of these questions. Your first step is to reach out to us for a consultation. We have an insurance concierge who works directly with your insurance provider to see what transgender medical insurance benefits you have.
Our insurance advocacy team will take you through every step of the insurance approval process until either approval is achieved or when it becomes clear that you do not have coverage. Because one of our main goals is to get your gender confirmation surgery covered by insurance, we provide the insurance advocacy work as a free service to all of our patients to give everyone the best chance of success.
Our team has experience securing insurance approvals for our surgeons to work with the following insurance providers:
To help us verify the benefits, we will need the following information from you:
Once we have your information, we will contact the insurance company and then let you know as soon as we hear from them. When we contact you, we’ll present one of the following scenarios:
If Scenario A happens, our team will help you explore the two options listed above.
This scenario can be further broken down into two possibilities:
Possibility #1: Your insurance is with Anthem Blue Cross, Blue Shield, or Brown & Toland. Our practice has agreements with these providers so your approval process should be smooth and straightforward.
What we will need from you for authorization approval:
There may be additional requirements based on individual circumstances.
Once we receive the necessary documents, we’ll start the request for authorization right away! It takes 4-6 weeks to receive a response from the insurance providers with whom we have an agreement.
Possibility #2: You have health insurance that covers gender confirming surgery, but our surgeons do not have an agreement with these providers
There are a couple of ways to have your surgery covered, even if our practice doesn’t have an established agreement with your company:
Your insurance would treat this case as ‘out-of-network’. It is still beneficial to go through the authorization process because this can greatly reduce your hospital expenses, and usually your insurance will pay for a portion of the surgery.
It’s important to clear up that there’s not ‘one’ insurance company that is ‘the best’ when it comes to covering transgender healthcare. However, throughout the years of working with different insurance companies that cover gender confirming surgeries, some companies have a higher trend of approvals versus denials. Gender confirming surgery insurance approval is based on a variety of factors that could potentially disqualify a patient for approval, no matter how ‘good’ your insurance is. Remember, you’ll want to find a surgeon who accepts your insurance. These factors include:
First, is the coverage:
Second, if a patient meets the gender affirming care guideline, most insurances have the same guidelines that they follow with WPATH and this is where the support letter comes in.
Larger companies that we accept and have seen decent insurance approval rates are:
If you have the above health insurance and are looking for gender confirmation surgeons outside of our practice, try searching what surgeons are in network with your health insurance plan. Or, contact your insurance provider directly to see if they have information to guide you.
It can be exciting when you’re enrolled in health insurance that covers gender confirming surgery. After looking at your policy, you might even find that you have the best insurance for transgender healthcare. But when it comes down to it, it could be that they don’t have qualified surgeons in your network.
Your insurance provider is required by law to refer you to a surgeon who can perform the procedure.
Obtaining approval may seem like an overwhelming process. However, with our experienced staff to help, you’ll be able to maximize your insurance benefits without the hassle and stress.
And, just to boil this down to bite-size, here is a summary of most of this information as a flowchart, also downloadable as a PDF here:
The virtual consultation will be billed to your insurance company. We will accept the insurance reimbursement as payment in full.