Insurance FAQ for Top Surgery

The world of medical insurance coverage can be complex and difficult to navigate. Sadly, this is often even more so the case for transgender individuals.

There are certain do’s and don’ts that can help make the process easier for you. We are here to help you on your journey.

Book a Consultation in Boca Raton

If you are considering either male to female or female to male top surgery, a consultation is a good place to start. During your initial appointment, Dr. Jacobs will educate and inform you regarding the procedure, ask you many questions to get to know you, and answer any questions you may have. Our team has extensive experience with transgender surgery, and this includes the subject of insurance coverage. Don’t hesitate to reach out to us! We are happy to help you regardless of what your next step may be. Like most plastic surgeons, we don’t accept insurance coverage as payment. We will be more than happy to help you apply for reimbursement, however. We have lots of experience in helping patients get the maximum benefit possible.

Is Transgender Surgery a Medical Necessity?

Sadly, many transgender individuals still encounter discrimination, denial of care and even humiliation and bullying. Fortunately, many organizations are working to raise awareness and improve conditions for people transitioning from one gender to another, and the status quo is improving. The World Professional Association for Transgender Health has issued a Statement of Medical Necessity that clearly explains the role of sex reassignment procedures in helping people live without gender distress.

You can read the full statement on WPATH’s website, but key points include:

Gender Identity Disorder (also known as GID, transsexualism or gender dysphoria) is now a condition recognized by the APA (American Psychiatric Association).
Transgender surgery should be considered medically necessary and “reconstructive.”
Individuals do not need to undergo genital surgery to be recognized by society as a different gender. Genital surgery should not be considered an essential component of a transition.

Transgender Surgery Insurance Do’s

Steps that may help you get closer to achieving medical insurance coverage include:

Do collect letters of support from medical professionals.
Do educate yourself on the subject and make use of the available information. The TLDEF (The Transgender Legal Defense and Education Fund) website is a good place to start.
Do be willing to see a therapist and get a professional diagnosis of gender dysphoria. Any documentation you can get from medical professionals will be helpful.
Do gather information and documentation on your medical treatments relating to your transition so far. If you have already received insurance coverage for HRT (hormone replacement therapy), it is a good idea to provide documentation of your coverage for HRT as evidence that future medical treatment is indicated.

Transgender Surgery Insurance Don’ts

Avoid making the following mistakes:

Don’t assume that the information you are given from your insurance carrier is up-to-date or complete. Call them to discuss their exact requirements for coverage and get all the data.
Don’t give up if your first application for coverage is denied. You can send your request to a higher-level decision maker, and you can supply more information and documentation.
Don’t hesitate to ask for help. You can contact local organizations or contact the TLDEF for support and guidance.

Let us be a part of your transition journey

At Sanctuary Plastic Surgery, our entire team is ready to help you on your journey. We feel honored and privileged to be a part of your transition, and we can’t wait to help you through every step of the process. From your initial consultation through all the steps of your surgery and recovery, we are here to help make your transition as smooth and enjoyable as we possibly can.