Has anyone had success challenging insurance for transgender top surgery?

I have insurance through the healthcare marketplace. They are denying coverage for all trans related healthcare. Hormones, surgery, counseling, everything. Has anyone successfully challenged a denial like this? I am wondering if a surgeon could help me have my insurance cover my surgery despite them having a denial in the coverage.

Doctor Answers 3

Insurance for top surgery

This is a very frustrating situation.  Sometimes the denial can be overturned by a letter of appeal from either your primary care physician or the plastic surgeon who is planning on performing the top surgery. 

Beverly Hills Plastic Surgeon
5.0 out of 5 stars 11 reviews

Problems with insurance coverage

There are many problems with insurance coverage of transgender surgery, even when the policy specifically states that the procedure is covered. We have become very frustrated with the insurance companies callous approach to this situation. Be sure to get everything in writing and prepare for stormy seas.

Sheldon Lincenberg, MD
Atlanta Plastic Surgeon
4.7 out of 5 stars 26 reviews

FTM surgery covered by insurance

I'm sorry you're having a hard time getting the services you need for your transition. Unfortunately, many insurance companies have specific exclusions written into their policies. Depending on the type of insurance plan, they may be well within their rights to deny certain procedures. That being said, many times denials can be overturned if an appeal is made by the healthcare professional. Specific to trans surgery however, any reputable board-certified plastic surgeon performing FTM breast surgery will require a letter from the therapist showing appropriate counseling and gender identity disorder diagnosis prior to performing surgery  Although I do not know your particular details, you may be best served by beginning with your primary care physician or therapist to see if an appeal can be made. Best of luck.

Anthony Deboni, MD
Syracuse Plastic Surgeon
4.9 out of 5 stars 32 reviews

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