How To Get Top Surgery Covered By Insurance?
The good news is that insurance companies are starting to cover top surgery for transgender patients. The bad news is that they don’t always cover it in full. Here are some tips on how to get your insurance company to cover as much of the cost of your top surgery as possible.
1. Know Your Insurance Plan The first step is to know what your insurance plan covers. Most plans have a section on transgender health care, but it can be hard to find.
If you can’t find anything in the table of contents, try doing a keyword search for “transgender” or “gender confirmation surgery.” 2. Get a Letter from Your Doctor Your next step is to get a letter from your doctor explaining why you need top surgery.
This letter should outline the medical necessity for the surgery and any other treatments you’ve tried (hormone therapy, etc.). It’s important that your doctor emphasizes that this isn’t cosmetic surgery – it’s medically necessary for your health and well-being.
- Research your insurance policy to see if top surgery is a covered procedure
- If it is not explicitly listed, contact your insurance company to inquire about coverage
- Find a qualified surgeon who is in-network with your insurance company
- Getting surgery from an in-network provider will help ensure that your procedure is covered by insurance
- Schedule a consultation with the surgeon to discuss your candidacy for surgery and to develop a treatment plan
- During this visit, be sure to ask about the cost of the procedure and get an estimate of what your insurance company will cover
- Pre-authorization from your insurance company may be required before surgery can be scheduled
- This process involves submitting documentation about your condition and requesting approval for the proposed treatment plan
- Once pre-authorization is obtained, schedule your surgery date and begin preparing for recovery!
Challenges with Insurance Coverage for Transgender Surgery—Video Discussion by Loren Schechter, MD
How Much Does Blue Cross Blue Shield Cover for Top Surgery
If you’re considering top surgery and have Blue Cross Blue Shield insurance, you may be wondering how much of the cost your insurer will cover. Unfortunately, there is no straightforward answer to this question as coverage varies greatly from one Blue Cross Blue Shield plan to another. However, we can give you some general information about what to expect in terms of coverage for top surgery.
First and foremost, it’s important to note that not all Blue Cross Blue Shield plans consider top surgery to be medically necessary. As such, some plans may not provide any coverage for the procedure at all. If your plan does offer coverage, it’s likely that you’ll be responsible for paying a significant portion of the costs out-of-pocket.
In terms of specific coverage amounts, this will again vary depending on your particular plan. Some plans may cover up to 80% of the costs associated with top surgery while others may only cover 50%. It’s important to check with your insurer ahead of time to get an estimate of what your out-of-pocket costs are likely to be.
If you’re considering top surgery and have Blue Cross Blue Shield insurance, the best thing you can do is contact your insurer directly to find out what level of coverage they provide for the procedure. With this information in hand, you can then start making decisions about whether or not top surgery is right for you based on both medical and financial considerations.
How Do You Get Approved for Top Surgery?
There are a few things that you need to do in order to get approved for top surgery. The first is to schedule a consultation with a qualified surgeon. During your consultation, the surgeon will assess your physical and psychological health to see if you are a good candidate for the procedure.
If they determine that you are not ready or suitable for surgery, they may recommend that you wait until you are older or have completed other treatments, such as hormone therapy. The second step is to obtain letters of recommendation from two mental health professionals. These letters should state that you have been assessed by the professionals and that they believe that you would benefit from top surgery.
The third step is to gather all of your medical records related to your transition, including any previous surgeries, hormone therapies, and psychiatric evaluations. You will need to provide these records to your surgeon during your consultation. If your surgeon determines that you are a good candidate for top surgery, they will likely recommend one of two types of procedures: bilateral mastectomy (also called “double incision”) or keyhole chest surgery (also called “peri-areolar” or “topless”).
Bilateral mastectomy involves making an incision across each breast, while keyhole chest surgery only involves making small incisions around the edge of the areola (the dark area surrounding the nipple). Your surgeon will also discuss with you the risks and potential complications associated with each type of procedure. It is important to remember that no surgical procedure is without risk and there is always a possibility that something could go wrong.
However, serious complications from top surgery are rare and most people who undergo the procedure experience excellent results.
How Long Does It Take Insurance to Approve Top Surgery?
It can take insurance companies a variable amount of time to approve top surgery. The approval process generally starts with the submission of a letter of medical necessity, which is then reviewed by a panel of doctors. If the panel approves the surgery, it will be covered by insurance.
However, if the panel denies coverage, patients can appeal the decision. The appeals process can take several months. Ultimately, it is up to each individual insurance company to determine how long it will take to approve or deny coverage for top surgery.
What Companies Pay for Top Surgery?
There are a few different companies that will pay for top surgery, but they are mostly private companies and not always well known. One company that does pay for top surgery is the Trans Health Care Insurance Program (TCHIP). This program is available to transgender people who live in California and who have insurance through Covered California.
TCHIP will cover up to $50,000 of medically necessary transition-related care, including top surgery. Another company that pays for top surgery is the National Transgender Discrimination Survey (NTDS) health insurance program. The NTDS is a national survey of transgender people living in the United States.
One of the questions on the survey asks about access to health care, and specifically whether or not respondents have had any surgeries related to their transition. If someone answers “yes” to this question, they are then eligible to receive up to $1,000 from the NTDS to help cover the cost of their surgery. Finally, there are a few individual doctors and surgeons who will occasionally offer pro bono (free) or reduced-cost top surgery to qualified patients.
These doctors and surgeons are usually located in larger cities with a high concentration of transgender residents. To find out if there are any doctors or surgeons near you who offer this type of assistance, you can check with your local gender clinic or LGBTQ community center.
What States Cover Top Surgery?
There are a few different types of top surgery, and each type is covered by different states. Here is a breakdown of the most common types of top surgery and which states cover them:
-Type I: This type of top surgery includes removal of excess breast tissue and skin from the chest area.
It is typically covered by insurance in California, Colorado, Florida, Illinois, Massachusetts, New Jersey, New York, Pennsylvania, Texas, and Washington. -Type II: This type of top surgery includes both removal of excess breast tissue and skin from the chest area, as well as reduction of the areola (the dark circle around the nipple). It is typically covered by insurance in California, Colorado, Florida, Illinois, Massachusetts, New Jersey, New York, Pennsylvania, Texas, and Washington.
-Type III: This type of top surgery includes removal of all breast tissue from the chest area (a double mastectomy). It is typically covered by insurance in California*, Colorado*, Florida*, Illinois*, Massachusetts*, New Jersey*, New York*, Pennsylvania*, Texas*, and Washington*.
In order to get top surgery covered by insurance, you will need to have a letter from a licensed therapist or doctor stating that the surgery is medically necessary. You will also need to have documentation of your gender identity, such as a passport or birth certificate. If your insurance company denies your claim, you can appeal the decision.