Note: Utilizing insurance for Facial Feminization and Breast Augmentation procedures – Our office is experiencing reimbursement issues (claims NOT being paid by insurance companies) when filing facial feminization procedures and breast augmentation to insurance. Receiving a pre-authorization or pre-determination from a patient’s insurance company does not guarantee payment. Because of the uncertainty of reimbursement it is our office policy to no longer submit any insurance pre-determinations or pre-authorizations for facial feminization or breast augmentation procedures. We appreciate your understanding.
Your first step should be to review your individual insurance policy. There must be transgender benefit coverage available on your plan in order for surgery to be covered. Review your plan carefully or contact your company’s benefits department for assistance. Some policies specifically exclude transgender surgical procedures. If you policy covers transgender procedures, we invite you to schedule an in-office consultation with one of our physicians to discuss your intended procedure(s).
At the time of scheduling your consultation please let the coordinator know that you intend to use your insurance and have your insurance card available as we will need information and phone numbers located on your card. Please bring all required letters and/or documentation with you to your consultation so that we can submit everything required by your insurance company.
**Please note that every plan has a different level of benefit coverage and our office cannot quote your out-of-pocket responsibility unless you provide us with your insurance information.
Your surgery can be scheduled once the consultation has been completed and our office verifies that your desired procedures are covered by your insurance policy.
For our Out Of Town Patients: If you live more than a few hours away from the Dallas Metroplex we can gather preliminary information from you to determine benefit coverage for your intended procedure(s).
You must first review your policy to determine if you have transgender surgical benefits as described above. After you have confirmed that you do have transgender surgery coverage contact our office to receive information about the documentation needed for our office to determine your benefits. Be prepared to submit copies of your insurance card and state issued ID, photos as requested, and additional letters or documentation that may be required by your insurance company. Once we have determined your surgical benefits we will contact you to discuss the scheduling of your consultation and surgery during one trip to the Dallas area.
Despite our efforts to coordinate with Medicare, we have been unable to communicate with any Medicare representatives who can guarantee approval and reimbursement for transgender surgery. In addition, no one offered contractual agreements with us to provide service. In our test cases with Medicare coverage, there continue to be denials of our claims. Until we receive confirmations of coverage and proof of reimbursement, the language suggests only a lifting of the ban. As a result, we cannot accept Medicare for transgender surgery at this time with such uncertainty still in effect.