Hey guys! I am in need of some information reguarding health insurance covering top surgery. I am mostly interested in talking to people who have successfully used the insurance company Blue Of California. I have been reading only horror stories of being denied coverage even though the insurance companies say that there is coverage. So if anyone has any help on getting my surgery seccessfully covered through my insurance. Any help would be awesome. Thanks!

Is anything here helpful? It's recent, from March. Blue Shield Gender Reassignment Surgery Criteria

There's further related info here, and check the comments too: Anthem Blue Cross Releases Transgender Health Plan Benefits

This might also be helpful, it's the letter used by Dr. Mosser and he's successfully gotten Blue Cross to cover top surgery using this. FTM Top Surgery Insurance Letter Template

Is anything here helpful? It's recent, from March. Blue Shield Gender Reassignment Surgery Criteria

There's further related info here, and check the comments too: Anthem Blue Cross Releases Transgender Health Plan Benefits

This might also be helpful, it's the letter used by Dr. Mosser and he's successfully gotten Blue Cross to cover top surgery using this. FTM Top Surgery Insurance Letter Template

Hey, thanks man for the reply. I have read that article and have the policy on hand with all the criteria. I spoke to my insurance company and they insisted that I was covered if I met all the requirements. I am just worried about still being denied. I haven't read and or talked to anyone who have successfully had blue shield approve their claim.

Thanks for the link to the letter. Would you happen to have any info on what the therapist letter should say though? That's what I'm mostly concerned about.

Yes, see this post for info about what the therapist letter should include:
http://www.ftmsurgery.net/forums/t-insur...206#pid206

I think it's probably pretty important to also find a surgeon who really cares about getting these surgeries covered by insurance. Some surgeons will go pretty far advocating for you, have extensive experience working with insurance companies, and/or have a dedicated person on-staff who handles insurance claims. (From what I understand, it's a bit of an art!)

Also, you might find this helpful: My Insurance Requirements for Top Surgery by MK

Thanks Joshua for the help. I'll check out those links. You've been more than helpful.


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I hope there's something in those links that will help! The insurance situation is a mess and it's pretty hard for anyone to makes heads or tails of it. But it's more than worth the perseverance to get surgery covered!! Please report back about how that process works out for you.

I've had one client successfully navigate the gender reassignment surgery maze through Blue Shield of California. It took her a lot of persistence, but it was ultimately approved at the beginning of June.

It is just crucial that all the requirements are met including all those pesky multiple letters from health care professionals. The heath insurance companies usually have a team of people that review all the documentation you submit. Consequently, it all has to be in order.

Don't be discouraged if it initially gets denied. Just follow up with them and find out in what areas your support documents were lacking. They are following their internal rules in order for the procedures to be approved.

So far, Blue Shield and Blue Cross are working with transgender members to meet the requirements set out in the Insurance Gender Non-Discrimination Act that enables health plans to cover the gender reassignment surgery.

I've had one client successfully navigate the gender reassignment surgery maze through Blue Shield of California. It took her a lot of persistence, but it was ultimately approved at the beginning of June.

It is just crucial that all the requirements are met including all those pesky multiple letters from health care professionals. The heath insurance companies usually have a team of people that review all the documentation you submit. Consequently, it all has to be in order.

Don't be discouraged if it initially gets denied. Just follow up with them and find out in what areas your support documents were lacking. They are following their internal rules in order for the procedures to be approved.

So far, Blue Shield and Blue Cross are working with transgender members to meet the requirements set out in the Insurance Gender Non-Discrimination Act that enables health plans to cover the gender reassignment surgery.

Thank you for the reply! Could you possibly tell me when they first filed a claim for coverage? Did they say no first? And she fought the denial?