With time, more and more insurance companies are offering coverage for gender affirming Top Surgery. Virtually all the major ones presently do have benefits available. This is especially true regarding FTM and FTNB procedures. However, there has been an increasing number of insurance companies also offering coverage for MTF Top Surgery.
If you have health insurance and are considering Top Surgery, do you know if your insurance plan provides coverage?
If you do have coverage, do you know if you are responsible for a co-pay or deductible and, if so, how much?
Do you know what criteria need to be met before you can get approval for coverage of the surgery?
Finally, you also may want to know if your plastic surgeon is a provider under your specific plan. If not, you may want to know if your plan provides out-of-network benefits.
All of this may seem to be unnecessary, annoying, time consuming and maybe even overwhelming.
And, largely it is!
Especially the annoying, time consuming and overwhelming parts.
Unfortunately, you will ultimately need this information if you are attempting to have insurance “cover” your top surgery.
However, there is also some good news.
If you do elect to have me, Dr. Turkeltaub, perform your Top Surgery procedure, we will take care of all of this for you prior to scheduling your surgery. That means that you can avoid all the worrying, frustration, stress and wasted hours on the phone trying to get all the necessary information.
Aside from providing your insurance information, which should have already been provided for your consultation (a copy of your insurance card), the only other item that we will need is a letter from your mental health expert confirming your diagnosis of gender dysphoria.
Then, voilà!
We will find out if your insurance plan offers benefits for gender affirming surgery, if you have met the criteria for coverage, whether you have a deductible and/or co-pay and how much you would be financially responsible for.
However, if you feel adventurous and have lots of time on your hands, you can find out some of this information by reviewing your insurance policy closely including the exclusions and limitations section. Another approach is to contact the member services department of your insurance company where you should be able to obtain more extensive information. If your health insurance is through work and there is a benefits representative, you may also be able to get the answers you need.
Finally, if it turns out that Top Surgery is an exclusion and there is no coverage OR you actually have no insurance, you still have the option of cash pay/paying on your own. To make this more affordable for you, we have negotiated discounted package pricing for the procedure that includes costs for the outpatient center, anesthesia, surgical fee and pathology (when relevant).
So, either way, we have you covered.
If you have any questions on this or want to schedule your consultation with me, you can either call my office at (480) 451-3000 or contact us by email.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
