Facial feminization surgical procedures for trans girls now lined by UPMC | LGBTQ | Pittsburgh

Facial feminization surgical procedures for trans girls now lined by UPMC | LGBTQ | Pittsburgh

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As of this yr, UPMC is the primary well being insurer within the Pittsburgh space to cowl medically mandatory facial feminization surgical procedure for trans girls. FFS describes a set of surgical procedures together with hairline decreasing, jaw discount, rhinoplasty, and eyelid surgical procedure designed to make one’s face extra female.

“It’s the coverage of UPMC Insurance coverage Providers Division to cowl gender affirming (gender affirmation) surgical procedure when medically mandatory and lined underneath the member’s particular profit plan,” UPMC’s Coverage and Procedures Handbook for gender affirming surgical procedure reads. As of December 2021, lined surgical procedures now embrace FFS.

Most well being insurers nationwide, together with Highmark and Medicare, don’t cowl FFS for trans girls, categorizing the procedures as “beauty.”

Advocates say that, particularly relating to transgender folks pursuing surgical transition, the road between beauty and medically mandatory will not be as clear as most insurers suppose it’s. FFS, which may vary as much as $30,000-50,000 with out insurance coverage, has been reported to considerably have an effect on trans sufferers’ psychological well being and social welfare and is “arguably probably the most generally denied surgical procedure,” in response to a Could 2021 examine from The College of California.

In Pittsburgh, native trans-led nonprofit TransYOUniting is celebrating the announcement.

“We’re grateful that UPMC is working to offer extra culturally competent care and assist for the transgender inhabitants by supporting medically mandatory FFS and we encourage all insurance coverage suppliers to do the identical,” TransYOUniting says in an announcement to Pittsburgh Metropolis Paper. “FFS is life-saving care that has been denied to so lots of our folks, so that is the proper step in the proper path. We hope their insurance coverage protection coverage additionally means they’re offering culturally competent well being care and employment alternatives for our neighborhood members as nicely,” the assertion reads.

Even with this growth of protection, like with different gender-affirming surgical procedures, there are nonetheless standards one should meet to be able to get FFS lined.

To ensure that UPMC to contemplate FFS medically mandatory, they require, “a persistent, well-documented analysis of gender dysphoria,” together with “the will to reside and be accepted as an individual whose gender is completely different than intercourse assigned at delivery,” that causes medical misery or impairment in “social, occupational, or different essential areas of functioning.” Sufferers should even be no less than 18 years previous and in a position to give their knowledgeable consent, along with receiving one referral from a professional psychological well being skilled and 12 months of steady hormone remedy (except the affected person has a medical contraindication or is in any other case unable to take hormones).

“I wish to first say that we’re thrilled that UPMC has expanded protection to incorporate facial feminization surgical procedures and laser hair elimination,” Remy Black, Transgender Affected person Navigator at North Aspect’s Central Outreach Wellness Heart, wrote in an e mail to Metropolis Paper. “This coverage change will actually change the lives of transgender sufferers in our community who will be capable to entry high quality care to start dwelling in a physique that’s congruent with their gender identification,” she continued.

Black says that COWC “anticipate[s] some delays and rising pains” as UPMC works to verify trans sufferers have entry to “competent suppliers.” She additionally expressed a necessity for Pennsylvania to “catch as much as the requirements of protection set by New York and California, which have probably the most expansive Medicaid protection for transgender sufferers within the nation (together with protection for physique contouring, dermal fillers, and plenty of extra procedures associated to gender affirmation for transgender sufferers).”


This story has been up to date at 2:45 p.m. on Fri., Jan. 28 so as to add in further feedback from Remy Black of Central Outreach Wellness Heart.