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A Decade Under Review-Trends in Insurance Coverage and Wait Time For Gender-Affirming Top Surgery
Christina R. Kuhrau, BA; Ermina Lee, BS; Kiersten C. Woodyard De Brito, MD MPH; Douglas Dembinski, MD; Sarah Pickle, MD; Ryan Gobble, MD
University of Cincinnati
2025-01-10
Presenter: Christina Kuhrau
Affidavit:
Christina Kuhrau
Director Name: Dr. Ann Schwentker
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
PURPOSE: This retrospective review characterizes a decade of top surgery wait times and insurance denials at a Midwestern academic institution.
METHODS: Patients presenting for top surgery consultation between 2014-2024 were included. Insurance, gender affirming hormone therapy (GAHT), and time to surgery data were analyzed with Stata. Chi-square and t-tests were utilized for categorical and continuous variables, respectively. ANOVA was used for the effect of consultation year and months of GAHT on wait time. P-values <0.05 were significant.
RESULTS: Among 130 patients, 71% progressed to surgery, with a mean wait time of 249 days. 27 received insurance denials, 67% of which were issued by Medicare or Medicaid. Public insurers had the highest denial rates in 2017-2019. Consultation year affected pre-certification approval (p=0.01), progression to surgery (p=0.01), and time to surgery (p<0.01). Insurer and months on GAHT did not significantly impact wait time.
CONCLUSION: Over the decade analyzed, surgical wait time averaged eight months. Landmark insurance reform occurred during this period, notably the 2014 reversal of federal bans on gender-affirming surgery and 2016 codification of nondiscrimination protections in Section 1557 of the Affordable Care Act. 2021 and 2022 featured high surgical volume and few denials, likely reflecting decreased GAHT requirements and the reinforcement of Section 1557 following reversal efforts. These trends highlight continued improvements in access to gender-affirming care.
