Are you exploring an FTM Top Surgery in 2019? Below we have detailed changes in FTM Top Surgery Health Insurance Coverage from 2018 to 2019.
Do you need an FTM Top Surgery?
Before we start, it’s important to know that everyone’s transition is their own journey and there is no one-size-fits-all set of surgeries or steps to cure YOUR gender dysphoria. An FTM Top Surgery is not a requirement to be FTM and you shouldn’t feel that it is. The LGBT community is a loving community that celebrates diversity. If an FTM Top Surgery isn’t for you, stop reading now and check out this cute puppy.
What this Guide Includes:
The three largest US health insurance providers (Aetna, United Health, and Anthem Blue Cross) provide similar coverage and requirements for female-to-male patients (with gender dysphoria coverage). Here, we will explore the changes in coverage from 2018 to 2019 for FTM Top Surgery.
For up-to-date policy details, we suggest you check directly with your provider using the direct links provided at the bottom of this page.
Trials for Hormone Therapy
One key change in requirements for FTM Top Surgery coverage is the requirement for trials of hormone therapy. In 2018, it was not a requirement of the major three health insurance providers for patients to undergo hormone therapy before having an FTM Top Surgery. Now, we are seeing a trend where health insurance providers are having the requirements more stringent for those under the age of 18 to receive an FTM Top Surgery. Aetna has added a requirement for those under 18 to receive one-year of hormone therapy prior to undergoing Top Surgery.
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Letter of Referral for an FTM Top Surgery
In 2019, health insurers continue to require one letter of referral from a “Qualified Health Professional”. Anthem Blue Cross lists the requirement as: “One letter signed by the referring mental health professional is required; the letter must have been signed within 12 months of the request submission.” While it appears that there is no clear requirement for the time that an individual must be in contact with a health professional, health insurers continue to have stringent requirements of the letter. Aetna provides the exact format of the letter in their Gender Reassignment Surgery Guide. According to Aetna, your letter must include the following:
- Your general identifying characteristics. This would include results of the psychosocial assessment and any diagnoses.
- An explanation of the duration of the mental health professional’s relationship with you.
- An explanation that the WPATH criteria for your surgery have been satisfied.
- A summary of the health professional’s rationale for supporting your FTM Top Surgery Request.
- A statement about the fact that informed consent has been obtained from you.
- A statement that the mental health professional is available for coordination of care and is available for this.
Documentation of Gender Dysphoria
One requirement for FTM Top Surgery in 2019 is the “Persistent, well-documented gender dysphoria”. While there is no clear outline for the requirements for such documentation, health insurers provide a key outline for what gender dysphoria is. Check the following insurance guides to ensure that you meet the documentation requirements for your plan Aetna, United Health, and Anthem Blue Cross.
Provider Specific links for FTM Top Surgery
- Anthem Blue Cross Blue Shield: Coverage for Gender Reassignment Surgery
- United Healthcare: Coverage for Gender Dysphoria Treatment
- HRC guide to Trans-related healthcare covering nearly all insurance policies