{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T09:35:16Z","timestamp":1791538516106,"version":"4.3.4"},"reference-count":49,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2020,8,10]],"date-time":"2020-08-10T00:00:00Z","timestamp":1597017600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:sec><jats:title>Objectives\/Hypothesis<\/jats:title><jats:p>To determine insurance coverage for gender\u2010affirming surgery and voice therapy for individuals who seek to align their voice with their gender identity, and to analyze differences based on state\u2010by\u2010state transgender equality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Cross\u2010sectional study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Policies from the top three commercial insurers per state in 2019 were reviewed. Coverage status was determined by web\u2010based search, telephone interviews, and email inquiries. A state\u2010by\u2010state equality score was calculated based on the number of laws and policies relating to the transgender community. Correlation between number of preauthorized procedures and state equality scores was assessed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 150 insurance companies reviewed, only four (2.7%) held favorable policies, whereas 113 (75.8%) provided no coverage. Endoscopic surgery, open surgery, individual voice therapy, and group voice therapy interventions were equally excluded (n <jats:italic>=<\/jats:italic> 93, 62.4%). Coverage was not correlated with laws driving transgender equality (<jats:italic>P<\/jats:italic> =\u2009.782).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Gender\u2010affirming voice interventions are seldom covered by commercial insurance companies. Despite established medical necessity and years of experience in practice, gender\u2010affirming interventions for voice have not yet been fully considered by third\u2010party payors. Further investigation regarding cost\u2010effectiveness and treatment efficacy is warranted to improve insurance coverage of voice\u2010related gender\u2010affirming care.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>NA <jats:italic>Laryngoscope<\/jats:italic>, 131:E896\u2013E902, 2021<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.28986","type":"journal-article","created":{"date-parts":[[2020,8,10]],"date-time":"2020-08-10T13:51:49Z","timestamp":1597067509000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["Coverage for <scp>Gender\u2010Affirming<\/scp> Voice Surgery and Therapy for Transgender Individuals"],"prefix":"10.1002","volume":"131","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7034-9238","authenticated-orcid":false,"given":"Elliana K.","family":"DeVore","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Massachusetts Eye and Ear Infirmary  Boston Massachusetts U.S.A."},{"name":"Department of Otolaryngology Harvard Medical School  Boston Massachusetts U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3274-4488","authenticated-orcid":false,"given":"Shekhar K.","family":"Gadkaree","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Massachusetts Eye and Ear Infirmary  Boston Massachusetts U.S.A."},{"name":"Department of Otolaryngology Harvard Medical School  Boston Massachusetts U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kayla","family":"Richburg","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Massachusetts Eye and Ear Infirmary  Boston Massachusetts U.S.A."},{"name":"Department of Otolaryngology Harvard Medical School  Boston Massachusetts U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth M.","family":"Banaszak","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Massachusetts Eye and Ear Infirmary  Boston Massachusetts U.S.A."},{"name":"Department of Otolaryngology Harvard Medical School  Boston Massachusetts U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiffany V.","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Massachusetts Eye and Ear Infirmary  Boston Massachusetts U.S.A."},{"name":"Department of Otolaryngology Harvard Medical School  Boston Massachusetts U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3927-3984","authenticated-orcid":false,"given":"Matthew R.","family":"Naunheim","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Massachusetts Eye and Ear Infirmary  Boston Massachusetts U.S.A."},{"name":"Department of Otolaryngology Harvard Medical School  Boston Massachusetts U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7786-7812","authenticated-orcid":false,"given":"David A.","family":"Shaye","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Massachusetts Eye and Ear Infirmary  Boston Massachusetts U.S.A."},{"name":"Department of Otolaryngology Harvard Medical School  Boston Massachusetts U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,8,10]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.7326\/AITC201907020"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11154-018-9459-y"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000005595"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2017.6231"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsxm.2016.09.003"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2018.01.003"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.prs.0000434415.70711.49"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1743-6109.2009.01370.x"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10508-005-7926-5"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1080\/15265161.2018.1531159"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000000545"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000002580"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/SCS.0000000000005499"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11136-010-9668-7"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000002171"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13178-017-0295-8"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1177\/2292550318767437"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1080\/15532739.2011.700873"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000006591"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000006012"},{"key":"e_1_2_6_22_1","volume-title":"State Health Insurance Laws & Guidance","author":"Transcend Legal","year":"2020"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1093\/asj\/sjz262"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvoice.2018.10.002"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otc.2019.03.007"},{"key":"e_1_2_6_26_1","doi-asserted-by":"publisher","DOI":"10.1080\/15532739.2015.1075931"},{"key":"e_1_2_6_27_1","doi-asserted-by":"publisher","DOI":"10.1097\/SCS.0000000000005132"},{"key":"e_1_2_6_28_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599817697050"},{"key":"e_1_2_6_29_1","doi-asserted-by":"publisher","DOI":"10.1300\/J485v09n03_08"},{"key":"e_1_2_6_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvoice.2016.07.018"},{"key":"e_1_2_6_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvoice.2006.05.005"},{"key":"e_1_2_6_32_1","doi-asserted-by":"publisher","DOI":"10.1097\/MOO.0b013e3283530f85"},{"key":"e_1_2_6_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvoice.2012.07.009"},{"key":"e_1_2_6_34_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1460-6984.2012.00185.x"},{"key":"e_1_2_6_35_1","doi-asserted-by":"publisher","DOI":"10.1159\/000083572"},{"key":"e_1_2_6_36_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2013.301789"},{"key":"e_1_2_6_37_1","volume-title":"Injustice at every turn: a report of the National Transgender Discrimination Survey","author":"Grant JM","year":"2011"},{"key":"e_1_2_6_38_1","unstructured":"America's Health Insurance Plans Center for Policy and Research. Health insurance: state\u2010to\u2010state 2019. Available at:https:\/\/www.ahip.org\/wp-content\/uploads\/StateDataBook_2019-FINAL.pdfPublished June 5 2019. Accessed March 29 2020."},{"key":"e_1_2_6_39_1","unstructured":"HenryJKaiser Foundation. Market share and enrollment of largest three insurers \u2014large group market 2018. Available at:https:\/\/www.kff.org\/other\/state\u2010indicator\/market\u2010share\u2010and\u2010enrollment\u2010of\u2010largest\u2010three\u2010insurers\u2010large\u2010group\u2010market\/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22 %22sort%22:%22asc%22%7D. Accessed March 31 2020."},{"key":"e_1_2_6_40_1","doi-asserted-by":"publisher","DOI":"10.1145\/1518701.1518946"},{"key":"e_1_2_6_41_1","unstructured":"Movement Advancement Project. Equality maps snapshot: LGBTQ equality by state: state data table. Available at:https:\/\/www.lgbtmap.org\/equality-maps\/. Updated April 7 2020. Accessed April 11 2020."},{"key":"e_1_2_6_42_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599820908860"},{"key":"e_1_2_6_43_1","unstructured":"United States Census Bureau. Statistical groupings of states of counties. September 2008. Available at:https:\/\/www2.census.gov\/geo\/pdfs\/reference\/GARM\/Ch6GARM.pdf. Accessed April 15 2020."},{"key":"e_1_2_6_44_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsxm.2017.06.007"},{"key":"e_1_2_6_45_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvoice.2006.09.009"},{"key":"e_1_2_6_46_1","doi-asserted-by":"publisher","DOI":"10.1111\/1468-0009.12297"},{"key":"e_1_2_6_47_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otorri.2015.02.003"},{"key":"e_1_2_6_48_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.mlg.0000205198.65797.59"},{"key":"e_1_2_6_49_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvoice.2009.06.004"},{"key":"e_1_2_6_50_1","doi-asserted-by":"publisher","DOI":"10.1177\/000348940211100602"}],"container-title":["The Laryngoscope"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Flary.28986","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/lary.28986","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/lary.28986","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/lary.28986","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,2]],"date-time":"2023-09-02T16:25:29Z","timestamp":1693671929000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/lary.28986"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,8,10]]},"references-count":49,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2021,3]]}},"alternative-id":["10.1002\/lary.28986"],"URL":"https:\/\/doi.org\/10.1002\/lary.28986","archive":["Portico"],"relation":{},"ISSN":["0023-852X","1531-4995"],"issn-type":[{"value":"0023-852X","type":"print"},{"value":"1531-4995","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,8,10]]},"assertion":[{"value":"2020-05-06","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-07-10","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-08-10","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}