- What surgical services will my insurance cover?
- I want to pursue gender-affirming surgery. What do I have to do?
- How do I find a surgeon who performs gender-affirming surgery?
- Where can I get the letters attesting that my surgery is “medically necessary”?
- Whom should I contact with additional questions about insurance coverage?
- What about fertility preservation?
- What if I have more questions about insurance coverage?
- Whom should I speak to if I encounter problems along the way?
What surgical services will my insurance cover?
All MIT-sponsored health plans include coverage for gender-affirming surgery. For complete details, see Gender Affirming Services [PDF] from Blue Cross Blue Shield of Massachusetts. For more information, students may contact the MIT Student Insurance Office at stuplan@med.mit.edu, and employees may contact MIT Benefits at benefits@mit.edu or call 617-253-6151.
I want to pursue gender-affirming surgery. What do I have to do?
You should begin by discussing your plans with your primary care provider (PCP), reviewing the Blue Cross Blue Shield of Massachusetts (BCBSMA) guidelines for surgery, and selecting a surgeon. If you haven’t already found a surgeon, your PCP can provide recommendations.
Once you have found a surgeon, confirm that they will accept BCBSMA insurance. Some surgeons do not accept insurance coverage and may require that patients pay for care out of pocket.
After you’ve confirmed that the surgeon accepts BCBSMA insurance, ask your PCP to submit a referral to that surgeon. Once the referral is approved, you may schedule an appointment for a surgical consultation. Depending on the type of surgery, the surgeon may need letters from your PCP and/or a mental health provider attesting that the surgery is “medically necessary.” (Surgical letter requirements are detailed in the BCBSMA guidelines.) Once the surgeon has agreed to proceed with surgery, the surgeon must submit a request for coverage directly to BCBSMA.
How do I find a surgeon who performs gender-affirming surgery?
There are surgeons who perform gender-affirming surgery at several hospitals in Massachusetts:
Where can I get the letters attesting that my surgery is “medically necessary”?
Based on type of surgery, your surgeon may require letters of medical necessity from your PCP and/or a licensed mental health clinician before they can submit the request for coverage to Blue Cross Blue Shield of Massachusetts (BCBSMA). Surgical letter requirements are detailed in the BCBSMA guidelines.
A PCP letter can be written by your MIT Health PCP or a primary care clinician you have seen outside of MIT Health.
If you received mental health care before coming to MIT, give your previous mental health provider a copy of the BCBSMA guidelines and ask them to write the letter. If you haven’t already seen a mental health provider who can provide this letter, you can see a provider in MIT Health’s Student Mental Health & Counseling Services.
Whom should I contact with additional questions about insurance coverage?
Students may contact the MIT Student Insurance Office at stuplan@med.mit.edu and employees may contact MIT Benefits at benefits@mit.edu or call 617-253-6151. They will either answer your questions or direct you to someone who can provide answers. Do not contact the MIT Health Billing Office with questions about insurance coverage.
Sometimes you might need to call Blue Cross Blue Shield of Massachusetts (BCBSMA) to get an answer. If you call BCBSMA, make sure to tell them you are from MIT, so they can refer to MIT’s coverage guidelines. Always ask for the name of the person you speak to and get a reference number for your conversation. Write this information down in case you need to refer to it in the future.
What about fertility preservation?
Insurance provides limited coverage for sperm banking and egg freezing. Associated costs such as STD screening and semen analysis will be covered by your insurance and can be done at MIT Health.
There are several sperm banks in the area. The one closest to MIT and most frequently used by MIT is New England Cryogenic Center. Egg freezing must be done by a reproductive endocrinologist (fertility specialist). The fertility group in this area with the most experience caring for transgender persons is IVF New England.
What if I have more questions about insurance coverage?
Students should contact the MIT Student Insurance Office at stuplan@med.mit.edu, and employees should contact MIT Benefits at benefits@mit.edu or call 617-253-6151. They will either answer your questions or direct you to someone who can provide answers. Do not contact MIT Health’s Patient Billing Service with questions about insurance coverage.
Sometimes you might need to call Blue Cross Blue Shield of Massachusetts (BCBSMA) to get an answer. If you call BCBSMA, make sure to tell them you are from MIT, so they can refer to MIT’s coverage guidelines. Always ask for the name of the person you speak to and get a reference number for your conversation. Write this information down in case you need to refer to it in the future.
Whom should I speak to if I encounter problems along the way?
For questions about medical care, contact Colleen McDonald, NP.
For specific questions about benefits or insurance claims, Students may contact the MIT Student Insurance Office at stuplan@med.mit.edu and employees may contact MIT Benefits at benefits@mit.edu or call 617-253-6151.