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+--- Forum: FTM Top Surgery (https://www.ftmsurgery.net/forums/f-ftm-top-surgery)
+--- Thread: can i convince insurance to cover top surgery? (/t-can-i-convince-insurance-to-cover-top-surgery)
can i convince insurance to cover top surgery? - ghostmallows - 10-16-2018
[full medical policy here]
TL;DR, my insurance would cover psychotherapy, HRT, bottom surgery, and a hysterectomy, but it considers mastectomies to be "cosmetic" for some reason. My chest causes me a lot of distress (i was cursed with f-cup breasts. RIP :( ), and unfortunately, I am not able to wear a binder because I hurt my ribs a few years ago.
Is there anything that can be done? Am I just going to have to suck it up and try fundraising?
RE: can i convince insurance to cover top surgery? - Bananarama - 10-17-2018
Hiya ghostmallows,
Assuming you're still seeing your therapist, which is usually the go-between for your path forward, you should be able to applly for top surgery regardless of their policies. The insurer will automatically deny, but you can usually get what you need by filing an appeal afterward and making an arguement that the procedure is "medically necessary", which of course iit is. Full stop.
Best wishes, and please keep us posted.
Hugs and much love,
Melanie
RE: can i convince insurance to cover top surgery? - Joshua - 10-19-2018
Interesting policy, that they'll cover lower surgeries but not top. As Melanie indicated, the key will be proving medical necessity. Check this out and the links for where to get more help about navigating insurance and denials:
https://www.topsurgery.net/ftm-top-surgery-insurance-coverage-tips.htm
Trans Family SOS have helped many people get coverage including minors, which is a huge feat.
Hope this helps!