Insurance Coverage Disparities in Ancillary Gender-Affirming Procedures:

Analysis of Eye Augmentation, Voice Modification, and Body Contouring in Massachusetts

Jessica J. Farzan B.A., Anna Bogursky M.Ed., Quynh Anh (Annie) Phan B.S., Janelle P. Renterghem B.S., Wen Ting Zheng B.S., Joyce McIntyre M.D., Janice Lalikos M.D

 

GENDER AFFIRIMING SURGERY (GAS)

• "Top" surgery (mastectomy, breast augmentation)

• "Bottom" surgery (phalloplasty, vaginoplasty, and

metoidioplasty)

• Facial surgery (most commonly includes frontal bone

reduction, rhinoplasty, tracheal shave, and genioplasty)

1,2

SIGNIFICANCE

.

• GAS affirms gender identify, mitigating mental

distress and improving quality of life1,2,3

• Gender dysphoria - a highly individualized

experience

• Certain physical features may contribute to

greater dysphoria than others, varying from patient-

to-patient 4

OBJECTIVE

To analyze insurance coverage, costs, and claim

denials for three less common GAS— eye shape

augmentation (upper blepharoplasty), body contouring

(liposuction), and voice modification

(surgical/behavioral)— in Massachusetts,

comparing MassHealth and private insurers

CURRENT INSURANCE LANDSCAPE

Progress since 2010:

• Affordable Care Act (ACA) prohibited discrimination

based on gender identity 5

• 30 states + D.C.: Cover top and bottom surgeries

• 10 states: Deny Medicaid coverage for gender

affirming care (GAC)

• 20 states: Have no specific plans for coverage 6

Leaders in GAS Coverage:

Connecticut, Massachusetts, Washington 7