My insurance unexpectedly sent me partial reimbursement for top-surgery

The title says it all, but here’s the details:  Prior to surgery, I put a lot of effort into trying to figure out what I might be able to get reimbursed for.  I was on the phone with customer service for a long time one day; I scoured my insurance’s webpage; I tried to figure out codes and what they mean; my therapist called multiple times on my behalf.  I oscillated between feeling hopeful I might get partial coverage, and being convinced that there was no chance.

Ultimately it seemed like there was no chance.  I found a promising document at one point called, “Gender Reassignment Surgery Medical Policy,” followed by criteria to prove it is medically necessary.  Then I was told that that applies to some insurance policies with my insurance company, but my particular policy excludes this coverage, and that was the bottom line.

Still, people told me that it’s against the law to deny coverage, on a state by state basis, and my state should cover it.  I paid out of pocket, first for the surgeon’s fees in advance, and then for the surgical center, the day of.  After the fact, I asked my surgeon’s office to send me an itemized bill of what I’d paid for, and I submitted that to my insurance company, without much hope.  I figured it’d get denied, then I’d appeal and take it as far as I could.  Maybe I’d get some advice from my local gay alliance, etc.

About 2 weeks later, I got a piece of mail.  I didn’t open it because I didn’t care to read the bad news.  My spouse and I were leaving for vacation last Wednesday, and I figured I’d better open it before we left.  In case there was some deadline for appealing it.  I opened it up, and it was a check for $2,800.09!!!!  I yelled at my partner about it, the excitement of it, which must have been jarring because I almost never yell.  What an amazing way to start our trip!

That’s 47% of the surgeon’s fees (including 100% of the accommodations – staying at the surgeon’s guest room!)  I really could not believe it – either the person on the receiving end wasn’t paying attention at all, or they knew exactly what it was and had some strong personal beliefs of what should get to be covered!!

Now I’m just deciding if I should also get an itemized bill from the surgical center and try to get more money back…  Maybe I don’t want to push my luck…

It really paid off to just try, even though I didn’t believe anything would come of it!

Here’s a post I wrote earlier on this topic:
In February, I wrote GID: exclusion for top surgery coverage

28 risks of chest binding

Some well known information about binding was finally proven empirically, for the first time ever, and published last week in Culture, Health, and Sexuality:  An International Journal for Research, Intervention, and Care.  The data was collected in the form of an online survey, where participants self-reported about their preferences, habits, and symptoms, as it relates to binding their chests.  The sample size was 1,800 people, from 38 countries, ages 18-66 years old, who were either assigned female at birth, or intersex, but encompassed 70 different gender identities.  The data was collected in April and May of 2014.

I highly recommend reading this article.  View the full article here:  Health impact of chest binding among transgender adults:  a community engaged, cross-sectional study.

Although very little from this study may be surprising among people who have experience with binding, this data is so important, because sometimes it takes surveys and studies to change public opinions, and hopefully that continues to happen sooner rather than later.  Specifically, if harmful effects are proven, maybe pressure will be put on health insurance companies so that more people can access top surgery.


97.2% of respondents reported at least one negative outcome from binding.  The most common symptoms were:

1. back pain (53.8%)
2. overheating (53.3%)
3. chest pain (48.8%)
4. shortness of breath ((46.6%)
5. itching (44.9%)
6. bad posture (40.3%)
7. shoulder pain (38.9)

Other symptoms included (and some of these are really severe):

8. rib fractures
9. rib or spine changes
10. shoulder joint “popping”
11. muscle wasting
12. numbness
13. headache
14. fatigue
15. weakness
16. lightheadedness/dizziness
17. cough
18. respiratory infections
19. heartburn
20. abdominal pain
21. digestive issues
22. breast changes
23. breast tenderness
24. scarring
25. swelling
26. acne
27. skin changes
28. skin infections

From the article:

“Although binding is associated with many negative physical health outcomes, it is also associated with significant improvements in mood and mental health. In response to open ended questions about mental health effects and motivations for binding, participants consistently affirmed that the advantages of binding outweighed the negative physical effects.  Many participants said that binding made them feel less anxious, reduced dysphoria-related depression and suicidality, improved overall emotional wellbeing and enabled them to safely go out in public with confidence.”

The most surprising finding from this study was,
“Commercial binders were the binding method most consistently associated with negative health outcomes, possibly because such binders have the potential to provide more compression than other binding methods. This finding is inconsistent with community perceptions that commercial binders represent the safest option.”
Another thought about this though:  binders were the most common, by far, so people are wearing these longer, and more consistently than other methods, which allows more severe symptoms to start to be apparent.  That seems pretty logical and straightforward.


different methods for binding your chest
The methods people reported using are as follows, from most common to least common:
-commercial binders
-sports bras
-shirt layering
-multiple sports bras
-elastic bandages
-athletic compression wear
-neoprene compression wear
-duct tape or plastic wrap
-belts, scarves, tight fabric, back braces, undersized swim suits, girdles, panty-hose

The first time I bound my chest, I used duct tape, for a drag show.  This was about 10 years ago.  I quickly moved on to ace bandages.  Shortly after, a trans-friend gave me one of his old binders that had stretched too much for him to feel comfortable in.  It was too big for me, but it was pretty effective anyway.  Still, I didn’t like it at all, preferring to just layer my shirts.  Over the next 10 years, I’ve purchased 2 binders from Underworks, and 3 binders that were actually almost tolerable, just compressing the breast region, and from the outside looking like a ribbed tank-top.  Still, I didn’t like it at all, and only very rarely wore any of these things.  Like, if we were going out and then going to a movie, I might wear the binder, but as soon as we’d get to the movie theater, I’d go to the bathroom just to take the thing off, because it’s not a huge deal, while sitting in the dark.

Many many people wear binders every single day, for over 8 hours per day, for years.  This study aims to understand how prevalent negative outcomes are, identify the risk factors, and develop evidence-based recommendations for health care professionals and people who bind.  I hope this study paves the way for future changes.  I’m just picturing binders coming with the warning, “May cause dizziness, drowsiness, headache, numbness, swelling… [etc.]  Talk to your doctor if…

If you’re interested in another study about trans- and gender non-conforming people, Here’s an interesting one that I summarized:  “A Gender Not Listed Here.”


-Works cited: Sarah Peitzmeier, Ivy Gardner, Jamie Weinand, Alexandra Corbet & Kimberlynn Acevedo (2016): Health impact of chest binding among transgender adults: a community-engaged, cross-sectional study, Culture, Health & Sexuality.