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Getting Your Hysterectomy Covered By Insurance

"I realized the one thing that made this entire surgery so uncomfortable was the same thing that made the surgery possible through my insurance: being a transgender male."

Caleb Camacho

Widespread explicit insurance coverage for gender-affirming Hysterectomy is still evolving but in many cases, Hysterectomy can be covered by health insurance. There are now many U.S. states that have laws that require health insurance plans to provide coverage for medically necessary services for transgender people, including preventive care and gender-affirming surgeries like Hysterectomy.

For patients covered by health insurance, out-of-pocket costs can range from co-pays of $100 or more and between 10% to 50% of the cost of the procedure.

However, many health plans are not subject to these state nondiscrimination laws and still use exclusions such as "services related to sex change" or "sex reassignment surgery" to deny coverage to transgender people for Hysterectomy. Check your Summary of Benefits and Coverage for the full terms of your insurance policy. Look for terms like "transgender," "gender change," "transsexualism," "gender identity disorder," and "gender identity dysphoria." Call the plan's issuer by phone if you need still clarity about whether or not gender-affirming Hysterectomy is covered. If you do have transgender health insurance exclusions in your plan, keep in mind that these may be unlawful in your state and you can file a complaint with your state's Department of Insurance, or to the Centers for Medicare & Medicaid.

Pre-Authorization
When submitting for pre-authorization, you will need to provide documentation to prove that Hysterectomy is medically required in your case. Include letters that explicitly state this from your primary care provider and a mental health professional.

Even with pre-authorization, insurance companies may deny coverage for other reasons, such as having an M gender marker. "Due to the fact that my insurance card had "M" for the gender marker... I was then sent the bill," wrote Ryan Sallans. After filing an appeal, Sallans was granted approval.

Dr. Adam Bonnington"To date we have not had issues with insurance coverage for the diagnosis of 'gender dysphoria', nor with having an 'M' on the ID, nor for non-binary patients," says Dr. Adam Bonnington, a gynecologist in San Francisco who works exclusively with trangender and non-binary individuals. "If someone is having issues with insurance coverage, common diagnoses that are traditionally covered are pelvic pain, symptomatic fibroids, irregular bleeding."

Appealing an Insurance Coverage Denial
If your health insurance company refuses to pay a claim or ends your coverage, you have the right to appeal the decision and have it reviewed by an independent third party.

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