Some of the most stressful questions arise when trying to figure out transgender surgery insurance. 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 approval is achieved, or until the point where it is clear that you do not have coverage. We provide the Insurance Advocacy work as a free service to give you the best chance of success, one of our main goals is to get your transgender surgery covered by insurance.
Our team has experience securing transgender insurance approvals for Dr. Mosser 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 get in touch with you as soon as we hear from them. When we contact you, we’ll present one of the following scenarios:
And don’t worry, we’ll help you explore these two options.
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 a week or two to receive a response from the providers with whom we have an agreement.
Possibility #2: You have health insurance that covers transgender surgery but Dr. Mosser does not have an agreement with these providers
There are a couple of ways to have your MTF/N or FTM/N surgery covered even if Dr. Mosser doesn’t have an established agreement with your company. These include:
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. For instance, it’s possible for you to have 9010 arrangement in terms of in-network coverage pay while 70-30 for out of network.
It’s important to clear up that there’s not ‘one’ transgender surgery insurance that is ‘the best’. However, throughout the years of working with different insurance companies that cover transgender surgeries, some companies we have seen a higher trend of approvals v.s denials. Top 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 that you’ll want to find top surgery doctors who accept your insurance.
Companies that are larger that Dr. Mosser accepts and has seen a decent top surgery insurance approval rates are:
If you have the above health insurance and are looking for FTM/N top surgeons outside of Dr. Mosser try googling the below to see what top surgeons are in your network. Or, contact your insurance provider:
When you’re enrolled in health insurance that covers transgender surgery it can be really exciting. After looking at your policy you might even find that your policy has the best insurance for transgender coverage. But when it comes down to it, it could be that they don’t have FTM/N top surgery doctors and MTF/N top surgeons in your network.
Not to fear, your insurance provider is required by law to refer you to a surgeon who can perform the procedure.
Obtaining approval may look like an overwhelming process. However, with our experienced staff to help, you’ll be able to maximize your transgender surgery insurance benefits without the hassle and stress.
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