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Is Gender Confirmation Surgery Covered by Insurance?

deja nicole greenlaw

Deja Nicole Greenlaw

By: Deja Nicole Greenlaw*/TRT Columnist—

The year 2014 could be big for transgender people. There is a fairly good chance this year that gender confirmation surgeries (GCS) will become covered by many private insurances and by Medicare. Connecticut and a handful of other states have recently mandated that insurance companies operating in their state cover gender transition, which includes mental health counseling, hormone replacement therapy, and GCS. This is great news as the individual cost, especially for GCS, is way out of reach for many transgender people. At this time, all GCS surgeries are deemed cosmetic and not essential, so there is no insurance coverage in most cases.

Currently, most of the surgeries are performed by cosmetic surgeons or plastic surgeons who decide the price to be paid by the patient up front. If they don’t have the required money, then there will be no surgery. In the future, with insurance covering surgeries, it will not be as cut and dry. Insurance companies will cover the surgeries just as they cover any medical service. They will not meet and cover the surgeon’s price; there will be a gap. The insurance company will set what they think is a fair price, which will most likely be pretty far from the surgeon’s price. It is unclear what will happen next, but I do have an insurance story to tell about my quest for GCS three years ago. 

I never really liked the idea of only a cosmetic or plastic surgeon working on my genitals, so I looked for other surgeons. 

My insurance company elected to pay for GCS surgeries. The coverage was to begin on January 1 of the new year. I knew about this upcoming coverage, so I began working on my GCS that fall. I never really liked the idea of only a cosmetic or plastic surgeon working on my genitals, so I looked for other surgeons. I found a team of two surgeons, a urologist to do the inside workings, the altering of the urinary tract and the restructuring of the orgasm system, and a cosmetic surgeon to perform the outside finish work. I met with each doctor and they had worked together performing GCS several times already. They told me that their clients were very happy. Both surgeons confirmed that they would work with my insurance company.

First, I worked with my urologist and his staff. They presented their price to my insurance company and they were denied coverage. The urologist’s staff informed me and I went straight to my insurance company for assistance. A few days later, the staff informed me that the insurance would cover only one-eighth of the urologist bill. Back to my insurance company I went for help again, but the end result was now one-fifth of the urologist’s bill. Once more I contacted my insurance company, and now the coverage was under 30 percent. My urologist and his staff were getting concerned. I was still determined to make this work.

The New Year came and I got a call from my urologist’s staff. Evidently my cosmetic surgeon had switched hospitals and was no longer working in the same hospital as my urologist. I still had high hopes of having my GCS, but now I figured that it would have to be performed in two steps and in two different places. First, the urologist would work the inside and then, on a later date, the cosmetic surgeon would work the outside. My urologist was not comfortable with my two step surgery idea. In the meantime, my insurance company was not budging from their under 30 percent coverage. I contacted my insurance company several times. I contacted the urologist’s staff several times. The breaking point was a 6 p.m. telephone call on a miserably sleeting winter night from my urologist. I could tell that he was calling me from his car because I heard his windshield wipers working. He told me that he was very sorry but that he could not do the GCS. He asked me to consider another surgeon. I didn’t want another surgeon, especially just a plastic surgeon. I wanted this particular team of surgeons, but it wasn’t going to happen.

So, when insurance coverage does begin for GCS, I cannot be sure of how anything will work out for anyone. However, people should be aware of potential roadblocks and a possible dead end as I experienced.

 *Deja Nicole Greenlaw is a local transwoman who has three grown children and works at 3M. She can be contacted at [email protected].

Filed Under: OpinionTransgender Topics

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