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Assessing the Landscape of Insurance Policies for Gender Affirming Surgery: A Survey-Based Analysis
Viraj Govani, BA
Alexander Comerci, MS
Tobi Somorin, BS
Nicolás Kass, MS
Janina Kueper, MD
Aaliyah Riccardi, MD
Ashley Rogers, MD
Jesse Goldstein, MD
University of Pittsburgh School of Medicine
2025-01-09
Presenter: Viraj Govani
Affidavit:
This project is representative of original work from the entire team
Director Name: Jesse Goldstein
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Aesthetics
Introduction:
Gender-affirming surgeries (GAS) enhance mental health by reducing distress, substance use, and suicide in transgender individuals. As demand grows, many insurance companies, including our institutional health plan, has expanded coverage. This study examines GAS insurance coverage and access challenges at our institution.
Methods:
Patients at a leading transgender care institution, from 2020-2024, were invited to participate in an IRB-approved Qualtrics survey featuring adapted questions from the 2015 National Transgender Survey and newly developed items. Descriptive statistics and chi-squared analyses (p<0.05) were conducted using STATA software.
Results:
The survey included 214 respondents (64.07% response rate); 77.36% were assigned female at birth, 36.93% identified as transgender, 19.85% as non-binary, and 6.28% as genderqueer. 70.95% had private insurance, 24.76% had public, 1.43% self-payers, and the remainder were unsure of their insurance status. Partial GAS insurance coverage was reported by 29.47% of participants (p=0.034) with insurance denial being reported by 10% of participants. Additionally, 7.35% noted the absence of in-network providers for gender-affirming care (p<0.001) and 8.11% of nonbinary individuals reported denials of hormone therapy (p<0.001). Coverage for specific procedures, such as facial surgery, varied significantly; the addition of coverage by our institutional health plan in 2021 significantly influenced the insurance decisions of 45.45% of transgender women (p=0.023).
Conclusion:
This study examined insurance coverage for GAS, finding higher denial rates for transgender women due to cosmetic classifications and nonbinary individuals due to restrictive eligibility criteria. While expanded coverage has increased demand, denials persist, underscoring the need for inclusive policies for equitable access.
