Farzan Jessica J, Phan Quynh Anh Annie, Renterghem Janelle P, Zheng Wen Ting, Bogursky Anna, Lalikos Janice F, McIntyre Joyce K
From the UMass Chan Division of Plastic Surgery, Worcester, MA.
Plast Reconstr Surg Glob Open. 2025 Jul 17;13(7):e6927. doi: 10.1097/GOX.0000000000006927. eCollection 2025 Jul.
Facial feminization surgery (FFS) is a component of gender-affirming care for transgender women and includes a variety of surgical procedures with the unified goal of improving patients' quality of life and mitigating mental distress. This study examined insurance coverage, costs, and claim denials for commonly desired FFS procedures in Massachusetts.
Data from the Massachusetts Center for Health Information and Analysis claims database (2016-2021) were analyzed for transgender patients undergoing FFS procedures in Massachusetts. The study focused on comparing costs and denial rates between public and private insurance for frontal bone reduction, eyebrow lift, upper and lower blepharoplasty, canthopexy, rhinoplasty, genioplasty, and tracheal shave.
A total of 656 FFS claims were analyzed, with tracheal shave as the most frequently claimed procedure (n = 176), followed by rhinoplasty (n = 165). Private insurance patients incurred 2-4 times higher out-of-pocket costs than public patients, who generally had no copayments. Additionally, private insurance exhibited significantly higher claim denial rates compared with public insurance.
Our findings revealed significant differences in insurance coverage, reimbursement, and claim denials for procedures across different insurance types in Massachusetts. These differences arise from varying interpretations of medical necessity, the dual cosmetic and functional nature of certain procedures, and the deeply personal experience of gender dysphoria. Our findings emphasize the need for expanded outcomes research on the efficacy and potential complications of FFS to better inform and enhance the comprehensive care provided to transgender patients.
面部女性化手术（FFS）是为跨性别女性提供性别确认护理的一个组成部分，包括各种手术程序，其统一目标是提高患者的生活质量并减轻精神痛苦。本研究调查了马萨诸塞州常见的FFS手术的保险覆盖范围、费用和理赔拒绝情况。
对马萨诸塞州健康信息与分析中心理赔数据库（2016 - 2021年）中接受FFS手术的跨性别患者的数据进行分析。该研究重点比较了公共保险和私人保险在额骨缩小术、提眉术、上下眼睑成形术、内眦固定术、鼻整形术、颏成形术和气管剃须术方面的费用和拒绝率。
共分析了656份FFS理赔申请，其中气管剃须术是最常申请的手术（n = 176），其次是鼻整形术（n = 165）。私人保险患者自付费用比公共保险患者高出2至4倍，公共保险患者通常无需支付共付费用。此外，与公共保险相比，私人保险的理赔拒绝率显著更高。
我们的研究结果显示，马萨诸塞州不同保险类型在手术的保险覆盖范围、报销和理赔拒绝方面存在显著差异。这些差异源于对医疗必要性的不同解读、某些手术兼具美容和功能的双重性质以及性别焦虑的深刻个人体验。我们的研究结果强调需要扩大对FFS疗效和潜在并发症的结果研究，以便更好地为跨性别患者提供全面护理并提高护理质量。
