Gender Surgery Beyond Chest and Genitals: Current Insurance Landscape
| Autor: | Caroline A Benzel, Katie L. McGlone, Shan Xue, Yvonne M. Rasko, Brooks J. Knighton, Jens U. Berli, Devin Coon, Erin M. Rada, Ledibabari M. Ngaage |
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| Rok vydání: | 2019 |
| Předmět: |
Gender dysphoria
medicine.medical_specialty Referral 030230 surgery Transgender Persons Insurance Coverage 03 medical and health sciences 0302 clinical medicine Hormone replacement therapy (female-to-male) Insurance policy Transgender Humans Medicine Genitalia Gender role Sex reassignment surgery (male-to-female) Insurance Health business.industry General Medicine Body Contouring medicine.disease Mental health Surgery Cross-Sectional Studies 030220 oncology & carcinogenesis business |
| Zdroj: | Aesthetic Surgery Journal. 40:NP202-NP210 |
| ISSN: | 1527-330X 1090-820X |
| DOI: | 10.1093/asj/sjz262 |
| Popis: | Background Plastic surgery plays an essential role in the treatment of gender dysphoria. International standards of care currently consider genital and chest surgeries to be medically necessary. Ancillary procedures such as facial surgery, chondrolaryngoplasty, hair restoration/removal, and body contouring are considered cosmetic surgeries except in individual circumstances. Objective The authors sought to assess the frequency of coverage provision for ancillary transition-related surgeries through a cross-sectional analysis of US insurance policies. Methods The authors selected insurance companies based on state enrollment data and market share. Policies were identified through web-based search and telephone interviews. A list of eligible procedures was compiled and grouped into 5 categories: body masculinization, body feminization, facial procedures, hair restoration/removal, and chondrolaryngoplasty. Medical necessity criteria from publicly accessible policies were then abstracted. Results Sixty-one insurance companies held an established policy. One-third of these policies offered favorable coverage for at least 1 ancillary procedure. Chondrolaryngoplasty was the most covered category (26%, n = 16), whereas body masculinization was the least covered (8%, n = 5). Almost two-thirds of the companies with favorable policies listed coverage criteria. We identified 4 recurring requirements: age, hormone therapy, continuous living in a congruent gender role, and referral from a mental health professional. Conclusions There is a low prevalence of US insurance coverage for ancillary gender surgeries and wide variability in coverage criteria. Reevaluation of ancillary transition-related procedures from cosmetic to medically necessary based on clinical judgement or establishment of defined coverage criteria may augment coverage and better address the needs of transgender patients. |
| Databáze: | OpenAIRE |
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