Insurance For Gender Affirming Breast Augmentation

Breast augmentation is a surgery not usually covered by insurance companies because it is often performed for cosmetic reasons. However, there are some cases where health insurance may cover breast augmentation surgery. The first case is when it is breast reconstruction such as after mastectomy due to cancer or similar reasons. Otherwise, insurance may cover breast augmentation when it is part of a transgender transition or a gender affirming purpose. Coverage for gender affirming breast augmentation widely varies and it can be difficult to navigate getting it covered. That’s why Allure Esthetic is here to help when it comes to figuring out insurance for gender affirming breast augmentation.

In Washington State, insurance companies cannot deny or limit gender affirming procedures when deemed medically necessary. Often, this requires a note from a mental health professional. Potentially, they may consider certain medical history such as a prescription of hormones. This will vary between companies and plans.

Out-of-state patients may not have this benefit. Some states do not have legislation that prohibits insurance companies from discriminating against gender affirming care by denying coverage. Allure Esthetic works with patients from all over the United States and can take certain out-of-state plans. We will be your advocate and ally.

If you have health insurance through your workplace, peruse all of the available plans to see if one offers coverage for gender affirming procedures and specifically breast augmentation. In Washington, most insurance companies will have some coverage for gender related surgeries. Though, the exact coverage will still vary.

If your workplace does not offer insurance that covers gender affirming breast augmentation or you do not have health insurance, Washington’s insurance marketplace is a great resource. It can help find an insurance plan that fits your budget and covers your needs. Outside of Washington State, this may be more limited.

Even if your insurance does cover breast augmentation, it often requires jumping over many hurdles to get it fully covered. Allure Esthetic can act as a liaison to simplify communication between you and your insurance company.

Initial Steps

At Allure Esthetic our insurance coordinators will help with all of the steps needed to help get you insurance coverage. Our insurance coordinators are trained specifically to advocate for gender affirming procedures and we will do our best to be your ally. Our insurance coordinators will help you with the below steps, however, if you choose to do them on your own, below are the steps to generally follow.

First, confirm coverage by contacting your insurance company and determining if the insurance company will offer coverage for gender affirming breast augmentation surgery. Next, if you have coverage, ask your insurance company what your out-of-pocket costs will be. Next, ensure that your chosen provider takes your insurance or that they can be billed out of network. Dr. Sajan is an in-network provider for all major commercial insurance carriers.

Finally, all insurance companies will have different requirements for covering surgery. Make sure that both you and your provider know what is necessary to move forward with surgery.

Things You May Need

Insurance companies sometimes require:

• Letter of support from a mental health professional
• Diagnosis of gender dysphoria from a mental health professional
• Confirmation that you meet WPATH guidelines
• Medical clearances
• Letter of agreement between Allure Esthetic and your insurance
• Documentation of hormone therapy or other transgender care
• Have identified in present gender for at least a year
• Proof that other mental and medical conditions are well treated

The exact requirements of your insurance will vary based on your company, plan, and state. You can often find this information online or by calling your insurance company. Our insurance coordinators are happy to help you and find out what is needed to get your breast augmentation completely covered.

Finding A Provider

The easiest and best way to find a provider contracted with your insurance is to log in to your insurance portal and browse the options. Many of these portals allow you to apply filters for certain procedures and geographic areas.

It is also important that you feel comfortable with and trust your surgeon. Surgeons who provide gender affirming care should have policies in place that specifically protect gender non-conforming patients. For example, at Allure Esthetic, preferred pronouns are always used and dedicated employees work with insurance companies concerning gender affirming surgeries.

What If My Insurance Does Not Cover Breast Augmentation Or You Do Not Take My Insurance?

Outside of insurance coverage, there are financing options. Allure Esthetic does work with financing companies such as Care Credit. This can help you undergo surgery without needing to pay the full amount upfront. Patients do and always can pay out of pocket if they are able.

Does Medicaid Cover MTF Breast Augmentation?

In Washington State, Medicaid does usually cover gender affirming breast augmentation. However, the number of providers that accept Medicaid for such procedures is extremely limited. This means that these providers are often booked out.

While Allure Esthetic does 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.

Is There Anyone To Help Me Get My Gender Affirming Surgery Covered?

Allure Esthetic employs dedicated insurance coordinators. They will work with both you and your insurance company to help get your procedure covered. They also have insight into the industry which makes them extremely talented and literate when it comes to insurance for MTF breast augmentation.

Do You Take Out Of State Insurance?

There are cases when Allure Esthetic can bill out-of-state insurance. However, this is largely on a case-by-case basis. If you are an MTF breast augmentation patient from outside Washington and want to know if your insurance may cover gender affirming breast augmentation at Allure Esthetic, contact our insurance coordinators by giving us a call or otherwise contacting us online.

How Much Is Breast Augmentation Out Of Pocket?

Breast augmentation surgery at Allure Esthetic starts at $5,995. This includes saline breast implants. Other types of breast implants will involve more cost. Other factors may also influence the final cost of your surgery such as the technique used. The best way to find out the cost of breast augmentation is to schedule a consultation with Dr. Sajan. At this appointment, he will make a surgical treatment plan with you. Once he gets a unique understanding of your needs, you will receive a customized price quote.

Allure Esthetic is Washington State’s top destination for gender affirming surgery. They accept most major insurances and work to help you get your surgery fully covered whenever possible. Health insurance is unnecessarily difficult when it comes to gender affirming surgery. Allure Esthetic works to make the process easier and less stressful.

Dr. Javad Sajan is a leading plastic surgeon who performs breast augmentation and other gender affirming surgeries. He is one of the top surgeons in the field and regularly performs facial and body gender affirming surgeries. To learn more and schedule a consultation, call us at (206) 209-0988. You can also reach out online using chat, online form, or Price Simulator.