A renewed call to expand coverage for gender-affirming facial surgeries

A renewed call to expand coverage for gender-affirming facial surgeries

A review of 150 insurance companies found that only 18% had policies that covered FFS.2 In contrast, genital and chest surgeries are pre-authorized by the vast majority of commercial insurance companies.2,3 Similarly, a review of state Medicaid policies found that of 18 states offering gender-affirm...

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Bibliographic Details
Published in:The American journal of surgery Vol. 230; pp. 101 - 102
Main Authors: Srinivasan, Tarika, Parsons, Matthew Q., Miller, Amitai S., DeVore, Elliana Kirsch, Cahill, Sean R.
Format: Journal Article
Language:English
Published: United States Elsevier Inc 01-04-2024
Elsevier Limited
Subjects:
Chest
Cisgender
Gender
Gender dysphoria
Gender identity
Gender reassignment surgery
Gender-affirming care
Government programs
Insurance
Insurance coverage
Insurance policies
Intervention
Maxillofacial surgery
Patients
Physicians
Policies
Prohibition
Quality of life
Surgery
Transgender persons
United States > US
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Summary:A review of 150 insurance companies found that only 18% had policies that covered FFS.2 In contrast, genital and chest surgeries are pre-authorized by the vast majority of commercial insurance companies.2,3 Similarly, a review of state Medicaid policies found that of 18 states offering gender-affirming coverage, only 3 included GFS.3 As such, the primary payer for GFS is often the patient, at an overall national rate of 36.4% compared to 9.2% for all other chest, gonadal, and genital gender-affirming surgeries.4 Per the 2015 US Transgender Survey, 55% of respondents were denied coverage for transition-related surgery, with GFS the most likely to be denied among all gender-affirming surgical options.5 Despite potential cost-prohibition, GFS accounts for approximately 5–10% of all gender affirming surgeries and continues to grow steadily in demand among patients.5,6 The clinical benefits of GFS for transgender and gender-diverse (TGD) patients warrant additional policies to cover elective facial surgeries for these specific populations. Though GFS serve to relieve gender dysphoria and improve quality of life, like all other gender-affirming interventions, they may not be inherently sufficient for those seeking gender affirmation. [...]it is difficult to measure these qualitative benefits against an absolute threshold of “medical necessity” for the treatment of gender dysphoria in isolation from other interventions such as psychiatric counseling. [...]we reaffirm that GFS are fundamentally elective, but their relative clinical appropriateness may be determined by the patient's definition of gender congruence and the physician's assessment of utility.
Bibliography:SourceType-Other Sources-1
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ISSN:0002-9610
1879-1883
DOI:10.1016/j.amjsurg.2023.11.014