Department of Facial Plastic and Reconstructive Surgery, Otolaryngology Associates, PC, 3801 University Drive, Suite 100, Fairfax, VA 22030, USA.
Facial Plast Surg Clin North Am. 2023 Aug;31(3):371-374. doi: 10.1016/j.fsc.2023.03.005. Epub 2023 May 16.
Insurance coverage of gender-affirming surgeries including facial and vocal feminization surgery remains a challenge for many patients, physicians, and practice administrators. These challenges range from disparities in coverage for commercial versus public insurance carriers, in network versus out of network benefits, preauthorization struggles, and the lack of standard coverage policies. This article aims to describe the insurance coverage and approval challenges related to facial feminization surgery and to provide guidance for surgeons and their practice administrators on how to obtain successful preauthorization/predetermination, single case agreements, and proper claim adjudication.
对于许多患者、医生和医疗机构管理人员来说，获得性别肯定手术（包括面部和声音 feminization 手术）的保险覆盖仍然是一个挑战。这些挑战包括商业保险与公共保险之间、网络内与网络外福利之间、预授权困难以及缺乏标准覆盖政策等方面的差异。本文旨在描述与面部 feminization 手术相关的保险覆盖和批准挑战，并为外科医生及其医疗机构管理人员提供获得成功预授权/预定、单项协议和正确理赔裁决的指导。
