Insurance For Gender Affirming Top Surgery

In the past decade, health insurance companies have slowly begun incorporating gender-affirming care into their coverage plans, including gender-affirming surgery. However, because many states and companies still do not offer insurance coverage for top surgery and other gender care, patients are often left to navigate this complicated system themselves. Allure Esthetic Plastic Surgery is here to help figure out insurance for gender-affirming top surgery, and we accept all major insurance carriers.

Insurance companies cannot deny or limit gender-affirming procedures when medically necessary for patients in Washington State. These companies generally require the patient to obtain a note from a mental health professional that clears them for surgical procedures. Insurance carriers may also consider specific medical history when deciding whether to provide coverage, such as a prescription for hormone replacement therapy.

Different insurance companies and policies have differing eligibility criteria, so it is essential to communicate with your insurance provider. Additionally, out-of-state patients may not have this benefit because some states do not have legislation prohibiting insurance companies from discriminating against gender-affirming care by denying coverage.

Allure Esthetic works with patients from all over the United States and accepts most out-of-state insurance plans. We will be your advocate and ally to help you obtain the gender-affirming care you deserve.

Finding Insurance That Covers Top Surgery

If your workplace provides health insurance coverage, carefully search all available plans to determine whether they cover top surgery. Most insurance companies in Washington and many other states will have some coverage for gender-related surgeries. Still, other states do not require insurance companies to cover gender-affirming procedures.

If your workplace does not offer insurance that covers FTM top surgery, or if you do not have health insurance, Washington’s insurance marketplace is the best place to start your search. The marketplace can locate an insurance plan that fits your budget and covers your needs. However, this may be more limited or unavailable outside of Washington State.

Even if your insurance provider and policy cover top surgery, you must usually meet additional criteria to cover it entirely. An example is how many companies will cover the top surgery procedure itself but will not cover reattaching the nipples. Allure Esthetic can shine as a liaison to simplify communication between you and your insurance company.

The Initial Steps

At Allure Esthetic, our insurance coordinators will guide you through all the steps to understand and obtain insurance coverage for FTM top surgery. Our insurance coordinators are explicitly trained to advocate for gender-affirming procedures, and we will do our best to be your ally. However, if you wish to complete the process on your own, follow these steps:

• First, confirm coverage by contacting your insurance company and determining whether they cover gender-affirming top surgery. Note that the procedure may also be referred to as a gender-affirming mastectomy.
• Next, if you have coverage, ask your insurance company what your projected out-of-pocket costs will be. Additionally, ensure that your chosen provider accepts your insurance or that they can be billed out of network if not. Dr. Sajan is proud to be an in-network provider for all major commercial insurance carriers.
• Finally, ensure that you and your medical team know what criteria you’ll need to meet to obtain coverage. Because all insurance companies have different requirements for covering gender-affirming surgery, it is imperative to ensure that both you and your provider know what is necessary to move forward with surgery.

What You May Need

What you will need to provide to your insurance will vary based on your company, insurance plan, and the state where you live. You can generally find this information online or by contacting your insurance company.

Our insurance coordinators at Allure Esthetic are happy to help determine what is needed to get your top surgery wholly covered. Insurance companies usually require:

• A letter of support from a mental health professional
• A diagnosis of gender dysphoria from a mental health professional
• Confirmation that you meet WPATH guidelines
• Various medical clearances
• A Letter of Agreement between Allure Esthetic and your insurance provider
• Documentation of hormone therapy or other transgender care
• Have identified in your present gender for at least one year
• Proof that other mental and medical conditions are well-treated and will not interfere

Finding A Surgeon

The easiest and best way to find a surgeon contracted with your insurance is to access your online portal. Many of these portals allow you to apply filters for specific procedures and geographic areas, making this the quickest option for determining which surgeon may be right for you.

It is essential that you feel trust your surgeon and that you feel safe and comfortable with them. When considering different surgeons, remember that those who provide gender-affirming care should have policies that specifically protect gender non-conforming patients. For example, at Allure Esthetic, preferred pronouns are always used, and our staff receives extensive training on creating a gender-affirming environment.

What If My Insurance Does Not Cover Top Surgery Or You Do Not Take My Insurance?

Outside of insurance coverage, there are other financing options. Allure Esthetic works with financing companies such as Care Credit that can help you undergo surgery without paying the total amount upfront. Additionally, patients are always welcome to pay out of pocket if they can or want to.

How Can I Find Out If My Insurance Covers Top Surgery?

There are two primary ways to determine whether your insurance covers top surgery. First, access your insurance’s online portal to view your plan in detail. Your portal should also contain information about what your insurance does and does not cover. Alternatively, call your insurance provider and speak with a representative.

Allure Esthetic’s insurance coordinators can assist you throughout this process. Because they frequently work with all major insurance companies, they are likely familiar with your carrier and plan. Our insurance coordinators also have access to numerous resources to help get your questions answered.

Does Medicaid Cover FTM Top Surgery?

In Washington State, Medicaid generally covers gender-affirming top surgery. However, the number of providers that accept Medicaid for such procedures is minimal, so these providers are often booked out far in advance.

While we do not currently work with Washington State Based plans (Medicare/Medicaid), we work with out of state Medicaid plans on a case by case basis. Alternatively, we are happy to refer you to another Medicaid provider.

How Long Does It Take For Insurance To Approve Top Surgery?

Once your insurance company receives all the required information and documentation, it takes four to six weeks to get approval. Thanks to our dedicated insurance coordinators, they may reduce this time. Out-of-state patients may take longer to receive approval from their insurance provider.

Do You Take Out Of State Insurance?

Yes, Allure Esthetic does take some out-of-state insurance. Generally, it is billed through an in-state company, and some companies will consider this out-of-network usage. Our insurance coordinators work closely with out-of-state patients so that they may undergo surgery with Dr. Sajan at Allure Esthetic.

How Much Is Top Surgery Out Of Pocket?

The starting out-of-pocket cost for FTM top surgery at Allure Esthetic is $8,500, including anesthesia costs. However, if you desire or require areas of liposuction or a specialized technique, this may impact the overall cost

For a complete list of our prices, visit our price list. You can also get a customized price quote for all the procedures you are interested in using Price Simulator.

Allure Esthetic has provided hundreds of transgender, non-binary, and gender non-conforming patients with lifesaving top surgery. They work directly with insurance companies to get top surgery fully covered when possible. Because determining insurance coverage and working on getting your procedure covered is a long and exhausting process, our insurance coordinators are with you when handling insurance for gender-affirming top surgery.

Dr. Javad Sajan is a renowned plastic surgeon performing multiple top surgeries weekly. Patients come from all over the world for his expertise in gender-affirming surgery. To learn more and schedule a consultation, call us at 206-209-0988. You can also reach out online using chat, contact form, or Price Simulator.