Why Insurance Coverage Matters
Top surgery can be a life-changing step for transgender and nonbinary patients — but cost is often a major barrier. In Connecticut, many health insurance plans are required to cover medically necessary gender-affirming surgery, including top surgery. The key is understanding the approval process and having a knowledgeable surgical team to guide you.
At Jandali Plastic Surgery in Trumbull, we help patients from Bridgeport, Fairfield, Stratford, Milford, Shelton, Westport, Norwalk, Easton, Monroe, Derby, Ansonia, Seymour, Oxford, Newtown, Bethel, Weston, Wilton, and Southbury navigate insurance requirements from start to finish.
Connecticut’s Insurance Landscape for Top Surgery
Connecticut is considered one of the more progressive states for transgender healthcare coverage. Under Connecticut Public Act 17-118 and related non-discrimination laws, insurers regulated by the state cannot deny medically necessary gender-affirming procedures.
What this means:
- If you meet the medical necessity criteria, your insurance plan must provide coverage.
- Out-of-state insurers may have different rules, but many follow similar guidelines.
Step-by-Step: How to Get Insurance Approval for Top Surgery
1. Confirm Your Coverage
- Call your insurance company and ask:
- “Does my plan cover CPT code 19303 (mastectomy) for gender dysphoria?”
- “Does my plan have out-of-network benefits?”
- Write down the representative’s name, date, and call reference number.
Choose a Surgeon Experienced in Insurance Submissions
- Our office has extensive experience working with Anthem Blue Cross Blue Shield, Aetna, Cigna, UnitedHealthcare, Oxford, ConnectiCare, and others.
- This experience often means fewer delays and higher approval rates.
Patient Perspective (Norwalk):
“I had no idea where to start. The office called my insurance, explained the steps, and I was approved in under two months.” — Alex, Norwalk
3. Gather Required Documentation
Most insurers require:
- Letter of Medical Necessity from a licensed mental health professional stating:
- Diagnosis of gender dysphoria
- Duration of living in your affirmed gender role
- Statement that surgery is medically necessary to alleviate dysphoria
- Supporting letters from your primary care provider or endocrinologist (optional but helpful)
- Photographic documentation may be required by some insurers (we handle this confidentially)
4. Meet Any Medical Criteria
While Connecticut law prohibits unnecessary barriers, some insurers may still list:
- Age requirements (often 18+, though exceptions exist)
- Documentation of hormone therapy (may be waived)
- No contraindications to surgery (e.g., uncontrolled health conditions)
We help identify and address these criteria early to avoid delays.
5. Submit a Complete Authorization Packet
Our office compiles:
- All required letters
- Your medical history
- Surgical plan
- Pre-op photographs (if required)
- Insurance forms
We send this as one complete packet to reduce back-and-forth delays.
Common Insurance Carriers Covering Top Surgery in CTAnthem Blue Cross Blue Shield
- Aetna
- Cigna
- UnitedHealthcare
- UHC Oxford
- Harvard Pilgrim Health Care
- ConnectiCare
Patient Perspective (Milford):
“I assumed top surgery was out of reach. When I learned my insurance covered it and the office handled everything, it was life-changing.” — Casey, Milford
Timeline for Insurance Approval
- Day 0: Submission of complete packet
- Week 2–6: Insurer review period (varies by carrier)
- Week 4–8: Approval or request for additional information
- Week 6–12: Surgery scheduling once approval is confirmed
Appeals: What If You’re Denied?
Even in CT, denials can happen — often due to missing documentation, misunderstanding of medical necessity, or insurer errors.
Our Appeal Process:
- Step 1: Identify reason for denial (review denial letter carefully)
- Step 2: Gather additional supporting documentation
- Step 3: Resubmit with a personalized appeal letter from Dr. Jandali
- Step 4: Request a peer-to-peer review if necessary
Our success rate with appeals is high because we handle the medical, legal, and administrative details.
Out-of-Network Considerations
If your insurance covers the surgery but we are out-of-network:
- We can request a network gap exception if there’s no qualified in-network surgeon nearby.
- This can allow you to receive in-network benefits for your procedure at our facility.
Local Convenience for Pre-Op & Post-Op Care
Frequent follow-ups before and after surgery are easier when your surgeon is close to home. We’re centrally located for patients in:
- Bridgeport, Fairfield, Stratford, Milford, Shelton
- Westport, Norwalk, Easton, Monroe
- Derby, Ansonia, Seymour, Oxford
- Newtown, Bethel, Weston, Wilton, Southbury
Insurance FAQs
Do I need hormone therapy before insurance will approve?
Many insurers have removed this requirement, but some still list it. We clarify for each patient.
Will insurance cover nipple grafting?
Yes, if it’s part of medically necessary top surgery.
Can minors get covered?
Possible with parental consent and documented medical necessity — varies by insurer.
How long is my approval valid?
Most approvals last 6–12 months, but confirm with your insurer.
Internal Links in Series
- Top Surgery 101 – Understanding the Procedure
- Top Surgery Recovery – Timeline, Scar Care, and What to Expect
- You are here: Insurance & Coverage for Top Surgery in Connecticut
- Choosing the Right Top Surgery Procedure
- Top Surgery FAQs – Expert Answers from Dr. Jandali
Call to Action
If you’re considering top surgery and want to understand your insurance coverage, we can help. Our team handles every step — from contacting your insurer to submitting appeals — so you can focus on preparing for your procedure.
Jandali Plastic Surgery
5520 Park Ave, Suite WP-2-300, Trumbull, CT 06611
Phone: (203) 374-0310 | Website: jandaliplasticsurgery.co
