The tide is turning in the United States, with more insurance companies recognising the medical necessity of gender-affirming procedures and funding Top Surgery.
What Healthcare covers top surgery?
It’s critical to understand that when it comes to transgender care, there is no such thing as “the best” insurance company. However, given my experience working with several insurance companies that cover transgender operations throughout the years, some have a higher rate of approvals than denials. Top surgery insurance approval is based on a number of factors that, regardless of how “excellent” your insurance is, may deny a patient. Always keep in mind that you’ll need to identify top surgery specialists who take your insurance.
Dr. Mosser accepts the following larger companies, who have a good top surgery insurance acceptance rate:
How do you get approved for top surgery?
According to the criteria, you must:
- Have you attained the legal age in your nation to make health-care decisions? (age of majority or age 18 in the U.S.)
What is the total cost of top surgery?
The cost of cosmetic surgery varies significantly based on your insurance coverage, where you reside, and which surgeon you choose.
Currently, the typical cost of FTM and FTN top surgery is between $3,000 and $10,000.
The average cost of MTF and MTN top surgery varies significantly according on body size, body shape, and desired breast size. The cost of this procedure often ranges between $5,000 and $10,000. A hospital or facility fee, as well as an anesthesiologist cost, are usually added to the overall payment.
Does Blue Cross Blue Shield il cover gender reassignment surgery?
The parents of a 15-year-old filed a federal lawsuit against Blue Cross Blue Shield of Illinois on Monday, alleging that the insurer’s regulations discriminate against transgender people “coverage for medically essential gender dysphoria treatment.”
Patricia Pritchard, the complainant, and her son, both have health insurance through the Catholic Health Initiatives Medical Plan, which is administered by BCBSIL “C.P.,” a subordinate. The lawsuit was filed in the United States District Court for the Western District of Washington on behalf of the parents, and claims that BCBSIL rejected coverage for C.P.’s gender dysphoria.
According to the lawsuit, BCBSIL initially covered parts of C.P.’s treatments, such as testosterone injections and mental health therapy, but later rejected coverage. C.P.’s request for preauthorization for a Vantas implant to delay the start of female puberty was initially authorized by BCBSIL in October 2016. According to the complaint, C.P. had the implant in November 2016 and BCBSIL paid for it.
C.P.’s mother received a letter from the insurer in April 2017 alleging that coverage will be rejected because “The medical plan mistakenly approved treatment for transgender services.”
According to the lawsuit, the plan didn’t clearly exclude coverage for gender-reassignment or gender dysphoria treatments in 2017, and BCBSIL only included an exclusion on January 1, 2018.
“According to the complaint, “benefits shall not be paid for treatment, pharmaceuticals, medicines, therapy, counseling services, and supplies for, or leading to, gender reassignment surgery.”
“Other Plan enrollees who are not transgender do not face a categorical exclusion barring coverage for medically essential health care based on their sex and get coverage for the same care that transgender enrollees do not receive,” the complaint continues.
According to the lawsuit, “The “sweeping exclusion” violates Section 1557 of the Affordable Care Act’s anti-discrimination provisions.
“Section 1557 of the Affordable Care Act specifically prohibits categorical bans on gender-affirming care because it is sex discrimination, plain and simple,” said Omar Gonzalez-Pagan, senior attorney and health care strategy for Lambda Legal, in a statement Monday.
The lawsuit seeks monetary damages as well as an injunction prohibiting BCBSIL from denying coverage for gender dysphoria therapy.
BCBSIL is enjoined from doing so by a court order “damages, legal fees, and costs for “administrating or enforcing health plans that exclude coverage for gender-affirming health treatment.”
Blue Cross has responded. A request for comment from Blue Shield of Illinois was not immediately returned.
The plantiffs are represented by Lambda Legal and Sirianni Youtz Spoonemore Hamburger PLLC.
P. et al. v. Blue Cross Blue Shield of Illinois, W.D. Wash., No. 3:20-cv-06145, Complaint filed 11/23/20, is the case.
Is Top surgery Medically Necessary?
For individuals who seek it, top surgery is a medically necessary intervention linked to improved overall subjective quality of life and lower incidence of gender dysphoria, substance abuse, HIV, and suicide.
How do you get diagnosed with gender dysphoria?
To be diagnosed with gender dysphoria, you must meet certain criteria, which vary depending on your age.
You must have experienced severe suffering for at least six months due to at least two of the following to be diagnosed with gender dysphoria as a teenager or adult:
- There is a significant discrepancy between your stated and experienced gender and your major or secondary sex traits.
- strong desire for the other gender’s primary or secondary sex characteristics
- strong belief that you have the other gender’s usual sentiments and behaviours
If a child has experienced considerable suffering for at least six months and at least six of the following, they are usually diagnosed with gender dysphoria.
- They have a strong desire to be of the opposite gender or insist on being of the opposite gender.
- strong fondness for toys, games, or hobbies that are stereotypically associated with the opposite gender
- strong opposition to toys, games, and activities associated with their gender
- strong desire for physical sex features that correspond to their gender experience
Childhood gender dysphoria is not a surgical diagnosis. It is a medical diagnosis that does not require treatment until a child reaches puberty, with the exception of perhaps individual or family counseling. A therapist or other mental health practitioner is usually the one to diagnose gender dysphoria.
What age can you get top surgery?
Top surgery is normally done after a person has started taking testosterone and has been presenting themselves socially as a man for a while. The physicians at UI Hospitals & Clinics adhere to the World Professional Association for Transgender Health (WPATH) standards of care, which require a single letter from a mental health specialist certifying readiness for surgery. Though the majority of people who get top surgery are over the age of 18, younger people may be considered if the patient, their legal guardians, and their mental health expert believe that it is necessary. Those who are mature enough to thoroughly understand the operation and have realistic expectations for the results are the ideal candidates for top surgery. Transmasculine people who plan to breastfeed should avoid male chest reconstruction.
How much does top surgery cost without insurance?
Knowing the out-of-pocket cost of Top Surgery and related costs will help you plan and schedule your surgery date if Top Surgery is not covered by your existing health insurance or if you are seeking Top Surgery privately.
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The cost of Top Surgery will vary depending on the technique and surgeon you choose. The Keyhole and Peri-areolar Top Surgery procedures are typically, but not always, less expensive than the Double Incision approach, saving up to $2000 USD.
In general, FTM Top Surgery costs between $5000 and $10,000 USD. Consultation fees may or may not be included. To book a surgical date, a deposit is normally necessary. The size of this deposit varies by surgeon, but it often ranges from $500 to $2000, and it can equal to up to 50% of the overall Top Surgery cost.
Hidden Fees: In addition to the surgeon’s charge, you’ll have to pay for an anesthesiologist, as well as possible facility fees, pathology fees, and other medical test fees. Ensure that the doctors you examine provide you with accurate information about the entire cost of Top Surgery.
You’ll also have to pay for things like a medical compression vest, prescriptions, paper tape, gauze, scar care, and more after the surgery.