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Updated: Sep 15, 2025

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Disparities in Facial Feminization Surgery Coverage: MassHealth Versus Private Insurance Coverage in Massachusetts.

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Summary

Facial feminization surgery (FFS) coverage varies significantly by insurance type in Massachusetts. Private insurance leads to higher out-of-pocket costs and more claim denials for transgender patients compared to public insurance.

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Area of Science:

  • Plastic Surgery
  • Health Services Research
  • Gender-Affirming Care

Background:

  • Facial feminization surgery (FFS) is integral to gender-affirming care for transgender women, aiming to enhance quality of life and reduce mental distress.
  • This study investigates insurance coverage, associated costs, and claim denial patterns for common FFS procedures within Massachusetts.

Purpose of the Study:

  • To compare insurance coverage, out-of-pocket costs, and claim denial rates for specific FFS procedures between public and private insurance plans.
  • To identify disparities in healthcare access and financial burden for transgender patients undergoing FFS.

Main Methods:

  • Analysis of 656 FFS claims from the Massachusetts Center for Health Information and Analysis claims database (2016-2021).
  • Focus on procedures including frontal bone reduction, eyebrow lift, blepharoplasty, canthopexy, rhinoplasty, genioplasty, and tracheal shave.
  • Comparison of cost and denial rates across public and private insurance types.

Main Results:

  • Tracheal shave and rhinoplasty were the most frequently claimed FFS procedures.
  • Private insurance resulted in 2-4 times higher out-of-pocket costs for patients compared to public insurance, which often had no copayments.
  • Private insurance plans demonstrated significantly higher claim denial rates than public insurance plans.

Conclusions:

  • Significant disparities exist in FFS insurance coverage, reimbursement, and claim denials based on insurance type in Massachusetts.
  • These differences are influenced by varying medical necessity interpretations and the complex nature of FFS procedures.
  • Further outcomes research is crucial to improve FFS efficacy, understand potential complications, and enhance comprehensive care for transgender patients.