{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T11:56:57Z","timestamp":1783166217023,"version":"3.54.6"},"reference-count":34,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2021,7,6]],"date-time":"2021-07-06T00:00:00Z","timestamp":1625529600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Facial Plastic Surgery &amp; Aesthetic Medicine"],"published-print":{"date-parts":[[2021,8,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Gender-affirming surgery may be pursued by individuals experiencing gender dysphoria. Although genital and chest procedures are classified as medically necessary, facial feminization surgeries (FFSs) are often considered cosmetic. Insurance companies may limit coverage of these procedures, especially in states less supportive of transgender individuals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>To determine insurance coverage and ease of finding policy information for FFSs, and to analyze differences based on state advocacy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Insurance policies for the top three commercial health plans per state were reviewed. Coverage status was determined by web-based search and telephone interviews. Ease of gathering policy information was assessed using a post-task questionnaire graded on a 7-point Likert scale, with higher numbers (e.g., 7) representing relative ease. State advocacy was determined by the number of state laws and policies affecting the transgender community.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Of the 150 insurance policies, only 27 (18%) held favorable policies for FFS. Most favorable companies covered chondrolaryngoplasty, with 78% (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u200921) offering preauthorization. Mean ease of use was rated 6, with 12 companies requiring a telephone interview. Insurance policies in states with laws driving transgender equity covered more FFS procedures (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.043), whereas those in restrictive states offered less overall coverage (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.023).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>FFS is rarely covered by commercial insurance companies, especially in states with less legal support for transgender individuals. Policy information remains difficult to obtain, with variable coverage by employer and no standardized medical necessity criteria. Limited coverage, lack of easily accessible information, and absence of universal criteria may act as barriers to FFS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/fpsam.2020.0226","type":"journal-article","created":{"date-parts":[[2020,8,31]],"date-time":"2020-08-31T11:15:04Z","timestamp":1598872504000},"page":"270-277","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":46,"title":["National Variation of Insurance Coverage for Gender-Affirming Facial Feminization Surgery"],"prefix":"10.1177","volume":"23","author":[{"given":"Shekhar K.","family":"Gadkaree","sequence":"first","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA."},{"name":"Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elliana Kirsh","family":"DeVore","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA."},{"name":"Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kayla","family":"Richburg","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA."},{"name":"Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda N.","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA."},{"name":"Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adeeb","family":"Derakhshan","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA."},{"name":"Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin C.","family":"McCarty","sequence":"additional","affiliation":[{"name":"Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA."},{"name":"Department of Surgery, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rahul","family":"Seth","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David A.","family":"Shaye","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA."},{"name":"Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2021,7,6]]},"reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2016.5549"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)00684-X"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.7326\/AITC201907020"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11154-018-9459-y"},{"key":"e_1_3_5_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000005595"},{"key":"e_1_3_5_7_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2017.6231"},{"key":"e_1_3_5_8_2","doi-asserted-by":"publisher","DOI":"10.1080\/15532739.2011.700873"},{"key":"e_1_3_5_9_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10508-005-7926-5"},{"key":"e_1_3_5_10_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1743-6109.2009.01370.x"},{"key":"e_1_3_5_11_2","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000004123"},{"key":"e_1_3_5_12_2","doi-asserted-by":"publisher","DOI":"10.1007\/s13178-017-0295-8"},{"key":"e_1_3_5_13_2","doi-asserted-by":"publisher","DOI":"10.1177\/2292550318767437"},{"key":"e_1_3_5_14_2","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000006591"},{"key":"e_1_3_5_15_2","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000006012"},{"key":"e_1_3_5_16_2","doi-asserted-by":"publisher","DOI":"10.1093\/asj\/sjz262"},{"key":"e_1_3_5_17_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2020.0235"},{"key":"e_1_3_5_18_2","unstructured":"America's Health Insurance Plans (AHIP) Center for Policy and Research. 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